HomeMy WebLinkAboutB16-0113 Application.pdf Department of Community Development
75 South Frontage Road West
TOWN OF VAIL 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: Project#:
4582 E Meadow Drive D-12
(Number) (Street) (Suite#) DRB#:
Building/Complex Name: Mountain Meadow Townhomes Building Permit#: B16-0113
Project Information: Lot#: Block# Subdivision:
Owner Name: Dennis Coughlin
Parcel#210112419012
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(( ) Addition(( ) Alteration((: )
www.eaglecounty.us/patie)
Contractor Information Type of Building:
Single-Family(( ) Duplex(( ) Multi-Family((• )
Business Name: The Fireplace
Commercial(f--) Other( )
Business Address: P.O. Box 2133
City Breckenridge State: CO Zip: 80424 Work Type: Interior(.) Exterior(i) Both(r)
Contact Name: Kim Garcia
Contact Phone: 970-453-2212 Valuation of
m breckfire lace.com Work Included Plans Included Work
ki
Contact E-Mail: @° p
I hereby acknowledge that I have read this application,filled out in full the Mechanical ((• )Yes ( )No (C)Yes ((•)No
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 ( .)Yes (C )No (( )Yes (C)No
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 ((—)No (( )Yes (C)No
Codes and other ordinances of the Town applicable thereto.
�/ Total Value of all work being performed: $4400.00
X 17 G/'z. tc., (value based on IBC Section 109.3&IRC Section 108.3)
Owner/Owner's Representative Signature(Required) Detailed Scope and Location of Work: Replace customers
Applicant Information
old worn out gas fireplace insert that is installed into the
Applicant Name: Kim Garcia
wood burning fireplace in the living room, with new direc
Applicant Phone: 970-453-2212
Applicant E-Mail: kim@breckfireplace.com vent gas fireplace insert.
Additional Authorized ProjectDox Users There will be no exterior alteration at the termination.
Full Name: (Photos attached as well as product documentation.)
E-Mail:
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