HomeMy WebLinkAboutD17-0001.pdf "<.%-°' Department of Community Development
75 South Frontage Road West
Vail, CO 81657
TOWN OF VAlL} r Tel: 970-479-2139
www.vailgov.com
BUILDING PERMIT APPLICATION
(Separate applications are required for Electrical,Alarm,Sprinkler&Public Way)
Project Street Address: 1,, Project#:
(Number) (Street) (J / 0 I C quite#) DRB#:
Building/Complex Name: Building Permit#:
1-1 '--0 0 0
Project Information: IV 1 L c'ft Lot#: Block# Subdivision:
Owner Name: r� fl
Parcel# .�t 0 9. 9--0 g o ® q
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(?),,Addition (Cs) Alteration(0)
www.eaglecounty.us/patie) m^ �
Contractor Information Type of Building:
Single-Family(C) Duplex(tom) Multi-Family(0)
Business Name: S''ref,/+t IAA,S l. Commercial (0) Other(0)
Business Address: 1 ct0 1. < WI Cif11 c 1
City + Y l` rh State: (-yo, Zip: g---46`t> Work Type: Interior Exterior(0 Both(0)
Contact Name: (V\ e Vi tv
Contact Phone: ;01) 0-/— Q 7 Valuation of
�_ Work Included Plans Included Work
Contact E-Mail: �. C.9 %* 4-c-avA0"A cle -' Ce r
I hereby acknowledge that I have read this application,filled out in full the Mechanical O)Yes ONo (C)Yes (C)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 (I )Yes (C)No (C)Yes ((No
mation and plot plan,to comply with all Town ordinances and state laws,
and to build this structu - g to the town's zoning and subdivision P�j�
codes,design re ' ap roved ternational Building and Residential Building (C)Yes (C)No (C)Yes (C)No
Codes and of r ordin ces • th-.Town applicable thereto.
f
Total Value of all work being performed: $
X (value based on IBC Section 109.3&IRC Section 108.3)
Owner/Owner's Repre` tative Signature(Required) Detailed Scope and Location of Work:
Applicant Informatio r /�� /
Ce,( Lf I . r �Do (mac t�P-� CPa (r t 44
Applicant Name: rvi1tN 1 tri daiw4f/
Applicant Phone: �^��/ {/yam// q�
3 1 - - c ., , �AA a.1 <j t( V
Applicant E-Mail: g) Si-r�tM✓tiR S.4-C4- , CCM"'
L-y i1
Additional Authorized ProjectDox Users �Q/ytt0 'T t d -� � , T,L\
Full Name: 1--4- `c I.017 C i S
E-Mail:
Full Name: (use additional sheet if necessary)
E-Mail:
(use additional sheet if necessary)
Date Received:
For Office Use Only: ' �`3-Fj _ RECEIVED
Fee Paid: 41 f Lb 2 0 2017
Received From:
Cash Check# Town of Vail
CC: Visa/MC Last 4 CC# exp date:
Auth #
Rev.2015-Dec