HomeMy WebLinkAboutB16-0474.pdfDepartment 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: /} Ju -Id fu1 MfL:rclft{) k fi(t; 57 __
(Number) (Street) (Suite#)
Building/Complex Name:--------------
Project Information:~ c F -/)
Owner Name: ,l~ J£l'CuV?l,q,J¢{ J: '1 <!.
Parcel# J/o/ C8J 77()/~
(For Parcel#, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Contractor Information
Business Name: wf ~ + /l(ui11:ttl!~
Business Address: /7{> W 9-( t!/ji .
City /)(rvf~vt-r State: c:o Zip: &'(!,:'IS
Contact Name: _l4_1 -"-L...V_,_f-+l.(--'-7--"-4v~-"'-(i"-'"y: _____ _
Project#: _________________ _
ORB#: __________________ _
Building Permit#: _ ____:::~=-,__/ -=0-~_0_lf_7_<{_,__ __
Lot#: Block# __ Subdivision: _______ _
Work Class: New ( Addition ( Alteration i)<f
Type of Building:
Single-Family ( Duplex ( ) Multi-Family (
Commercial &/_) Other (
Work Type: Interior (f} Exterior ( ) Both ( )
Contact Phone: ---'y'---"i2f)_~__.,2'-"'B--'-C;_-,-'--)_3 i----'-J-__ . -~-
Contact E-Mail: Ouf U)t,s I µte_cA &, Vui0J-Ct>?"--r
I
Work Included Plans Included
Valuation of
Work
I hereby acknowledge that I have read this application, filled out in full the
information required, completed an accurate plot plan, and state that all
the information as required is correct. I agree to comply with the infor-
mation and plot plan, to comply with a wn ordinances and state laws,
and to build this structure ace · o t town's zoning and subdivision
codes, ,1nt~ional Building and Residential
Codes of t~own applicable thereto.
Applicant Information
Applicant Name: -----------------
Applicant Phone: ________________ _
Applicant E-Mail: ________________ _
Additional Authorized Projectoox Users
Full Name: -------------------
E-Mail:. ____________________ _
Full Name: __________________ _
E-Mail:. ____________________ _
(use additional sheet if necessary)
For Office Use Only:
Fee Paid: _______ _,.,,=--=~------
Received From: ______________ _
Cash Check# ____ _
CC: Visa / MC Last 4 CC # ___ _ exp date: ___ _
Auth# ___ _
Rev. 2015-Dec
Mechanical ( )Yes
Plumbing >()Yes
Building ( )Yes
)No
)No
)No
)Yes )No
)Yes )No
)Yes )No
Total Value of all work being performed: $--rrd'--ttl_.'J ___ _
(value based on IBC Section 109.3 & IRC Section 108.3) P
Detailed Scope and Location of Work: _______ _
:!!f:!1!i~~
(use additional sheet if necessary)
Date Received: