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HomeMy WebLinkAboutB16-0255 application.pdfTOWN OF~ Department of Community Development 75 South Frontage Road West Vail, CO 81657 Tel: 970-479-2139 www.vailgov.com BUILDING PERMIT APPLICATION (Separate applications are required for Electrical, Alarm, Sprinkler & Public Way) · Project Street Address: Q 1-9 I P()i'f'rro pkQ-1 (Number) (Street) (Suite#) ·Building/Complex Name:------------- Project lnformatio"h..i [-!I OwnerName: ~ (, 1 V~ [!_~~uJ')' Parcel# 21tH ·0(,3··01 -OZ4 (For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit www.eaglecounty.us/patie) Contractor Information Business Name: ~~ /2. ~G Business Address:---------------- Project#:----------------- ORB#: _________________ _ Building Permit#: _]3""""""''--'/"""'0::;...._-_0----"'-Cf-_S_S ___ _ Lot#: Block# __ Subdivision:-------- ' , Work Class: New (Q) Addition (Q) Alteration (Q) Type of Building: Single-Family ~uplex (0) Multi-Family (0) Commercial (0) Other (0) _________ _ · City State: Zip: _____ . Work Type: Interior (0) . Exterio~ Both (Q) Contact Name: JV:-f" ~-Oft, f%1')J 'contactPhone:.3%·401?> J9t.> ·t.)'j()g Contact E-Mail:----------------- I hereby acknowledge that I have read this application, filled out in full the infonnation required, completed an accurate plot plan, and state that all the infonnation as required is correct. I agree to comply with the infor- mation and plot plan, to comply with all Town ordinances and state laws, and to build this structure according to the town's zoning and subdivision codes, design review approved, International Building and Residential Codes and other dinances of the Town applicable thereto. ·Mechanical Plumbing Building Work Included O)Yes (0No ~Yes (0)No 0)Yes (QNo Valuation of Plans Included Work (0)Yes (C~No (C~Yes (QNo 11000 (0JYes (C)No ; Total Value of all work being performed: $ I ( 0 a a X. __ -±;~ui<-...:t.4.1..:.:;' ....._~~...L-.!...-..:::::...~::__~'-"'-'--:.<.;:..-"-~ : (value based on IBC Section 109.3 & IRC Section 108.3) Owner/Owner's Representative Signature (Required) Applicant Information Applicant Name: Bto.C \3 U' < lo Applicant Phone: 9._ }_ D--~ 04 -'-1 ~ ~ . Applicant E-Mail: ():_.:l:'; I e i @ (ftciCi i)/ "iJ ) . c \,N\ i Additional Authorized ProjectDox Users Full Name: ------------------ E-Mail: ___________________ _ Full Name: ------------------ E-Mail: ___________________ _ (use additional sheet if necessary) For Office Use Only: . j_. 1 .<. . 7 <) Fee Paid: ----~J;z__~~!Z:::_'-" ________ _ Received From: ______________ _ Cash Check # ____ _ CC: Visa I MC Last 4 CC # ___ _ exp date: __ _ Auth# ___ _ Rev. 2015-Dec Detailed Scope and Location of Work:/ , GJ Le¥ t i:h1n6tv gy exca. )offet Cr-.s, M Jf\C(V\ ~ f'd 1 £Tfifl-.. ., lf1'1< LD cPnJ Ch) / s 60 rJ '< () errJ4f't / tJ rv 8' Y g{· g_. (use additional sheet if necessary) Date Received: ~©~OW~ JUL o::; 2016 u TOWN OF VAIL