HomeMy WebLinkAboutB16-0386 Application Department of Community Development
75 South Frontage Road West
TOWN O F VA 11. 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#:
�5 - P t�
y
(Number) (Stret (Suite#) ORB#: -
-Building/Complex Name: Building Permit#:
Project Inform lan: Lot#: Block# Subdivision:
Owner Name: -C' i
Parcel# "-Z—A
(For Parcel#,contact Eagle County Assessors Office at(970)328.8648 or visit _ Work Class: New(, ) Addition 0- Alteration(
www.eaglecounty.us!patie)
Type of Building:
Contractor Information
Single-Family(' J Duplex(r) Multi-Family( )
Business Name: r -�Commerclal( ) Other(r
Business Address:\fit)Q YYYL..),NRtel-
City . .tr\�LS.'.Q tir State:,( CN Zip: 41�9(.- 5 Work Type: Interior( ) Exterior( ) Both( )
Contact Name: 1c \N
Contact Phone: A10— 5`)'L Valuation of
Work Included Plans Included Work
Contact E-Mall: =C ;t„ • a.IL ► fj lY1
I hereby acknowledge that I have read this application,filled out in full the Mechanical r)Yes (r)No (r)Yes (C)No
information required,completed an accurate plot plan,and state that all 7,,�,
the information as required Is correct. I agree to comply with the Infor- Plumbing ( .Yes (r)No (C)Yes (r)No CSW
oration 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)Yes (r)No (r)Yes (C)No
Codes and other ordinances of the T wn applicable thereto.1u _
X (y ` I 1al , I t Total Value of all work being performed: $ ��
�j (value based on IBC Section 109.3&IRC Section 108.3)
Owne Owne Representative Signature wired) Detailed Scope and Location of Work:
Applicant Information
Applicant Name:
Applicant Phone:
Applicant E-Mail:
Additional Authorized ProjectDox Users
Full Name:
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