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HomeMy WebLinkAboutB16-0115 application.pdf Department of Community Development 75 South Frontage Road West TOWN OF°5IVAIVail, CO 81657 Tel: 970-479-2139 www.rrailgou.com BUILDING PERMIT APPLICATION (Separate applications are required for Electrical,Alarm, Sprinkler&Public Way) Project Street Address: Project#: (Number) (Street) (Suite#) DRB#: Building/Complex Name: %/(6....1—r3 +Q03f C\Lrif) Building Permit#: Project Information Lot#: Block# Subdivision: Owner Name: CCJSA y 12-1Z-Ar ( LC_ Parcel# 2-10 I ^ O& ?- —0440 — U'2- (For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(C) Addition (C) Alteration ( www.eaglecounty.uslpatie) Type of Building: Contractor Information Single-Family(C) Duplex O Multi-Family(C Business Name: �� PJL) x[5.1 ��SS O C-Commercial (C) Other(C) Business Address: City State: Zip: Work Type: Interior(f5 Exterior(C) Both (C) Contact Name: SN Contact Phone: Valuation of Work Included Plans Included Work Contact E-Mail: I hereby acknowledge that I have read this application,filled out in full the Mechanical))Yes (C)No AVYes (C)No 1 U 6 a information required,completed an accurate plot plan,and state that all the information as required is correct. I agree to comply with the infor- Plumbing XYes (C)No fYes ( )No /51 000 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 Building { )Yes (C)No (Wes (C)No til / t17O Codes and• er ordinances of the Town applicable thereto. • ( L/` Total Value of all work being performed: $ g®10 CAD X (value based on IBC Section 109.3&IRC Section 108.3) Owner/O n- s Representative Signature(Required) Detailed Scope and Location of Work: Applicant Information /� _ v' 444-e-A I-.m GI Applicant Name: C.r(N {1�-� [: ) th-RAS _ iv los 71--o Applicant Phone: hy Applicant E-Mail: � r J2 .�' 5.1400./.e r-S a--4- Additional Authorized ProjectDox Users CC✓Z /� Full Name: Liv V ize,,P-' `` © tA,y(/L/� J7" X6/K.2n !t'!1'11skt e3 E-Mail: LA- ll[� 5� 11(1,� � rj- l�(_1�X . Full Name: (use additional sheet if necessary) E-Mail: (use additional sheet if necessary) Date Received: For Office Use Only: Fee Paid: Received From: Cash Check# CC: Visa/MC Last 4 CC# exp date: Auth # Rev.2015-Dec