HomeMy WebLinkAboutB16-0492 application.pdfrnwx of va
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)
Pro ect Street Address: /
,r
(Number) (( r
Building/Complex Name:
(Suite #)
Project #:
DRB #:
Building Permit*
Project Information: rr Lot #:
Owner Name: SCA J�tc%/✓�,
Parcel # -_ If 2 C;Q00V
(For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit Work Class
a leco n s/ atie)
Block # Subdivision:
New ((—) Addition 7alteration (('�
vwvw.e g u ty.0 p
mi"'A
Contractor Information
Type of Building:
Single -Family ( uplex (�) Multi -Family ((7 )
/J
Business Name:jLh/�%r� �,��
Commercial (�) Other (( )
Business Address: 4 4 f� r�
city State: 6:) zip:
Work Type: Interior 01� Exterior (C) Both ((�)
Contact Name:
Contact Phone: /Ci - ?��
Valuation of
•�. r
Work Included Plans Included Work
Contact E -Mail:
I hereby acknowledge that I have read this application, filled out in full the
Mechanical �Yes(7)No ((—)Yes j�`��^
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 (i/f1�es ((—,)No OYes
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
Building (')Yes (�)No )Yes ((7)No
codes, design review approved, International Building and Residential
Codes and other ordinances of a Town applicable thereto.
��
Total Value of all work being performed: $ / 000 '
(value based on IBC Section 109.3 & IRC Section 108.3)
Ow wner's Rep r en a Signature (Required)
Detailed Scope 11 a 11 nd Location of Work:
pplicant Infor
q
�
Applicant Name:
Applicant Phone:
Applicant E -Mail:
Additional Authorized ProjectDox 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 #
Auth #
-.e I .+^•�c
(use additional sheet if necessary)
Date Received:
RECEIVED
exp date: DEC 09 2016
Rev. 2015 -Dec
Town of Vail