HomeMy WebLinkAboutB15-0085 ApplicationTOWN OF~ D1p1nm1nt of 8ommunl~ D1v1loWiltRIA&
'TS South l'rontage Road
Vall, CO 81657
Tel: 970-479°2128
www.vallgov.oom
Development Review Coordinator
BUILDING PERMIT APPLICATION
(Separate applications are required for alarm & sprinkler) ...---------""'9--------------------------. Project Street Address:
l~:Sf, ~l?!"s& .. t).
(Number) (Street) (lult1 #)
Building/Complex Name:-----------
Contractor lnform1tlon
I hereby acknowledge that I have read this application, filled out
in full the Information required, completed an accur1te plot plan,
and state that all the Information as required la correct. I agree to
comply with the information and plot plan, to comply with all Town
ordinances and state laws, and to build this structure according to
the town's zoning an · ion codes, d · iew ap-
proved, Intern a tial Co s and other
ordinanc th e to.
Applicant lnformatlen
Applicant Name: M1Ke ~v'l!i'.+b
Applicant Phone: i10 · '!:>1w • '64?>
Project#: _....:;:.a...:!....'-4-"-~ll!.!l..A...?-------
ORB #: _______________ ~
aulldlng Permit#: _.....:;,lj_S'--·..xD..xO:.xa .... 6'-----
Lot#:_ Block#_ Subdivision: ______ _
Valuation of
Work Included Plana Included Work
Electrical ~es· Qi>.Jo Qvea · (SrNo CP1eJ11t>
Mechanical {jJYea Q)No Qves ~o l 1 "DO
Plumbing ~es QNo Qves a-No /O 1 l)()O
Building (ifvea QNo ('ifvea QNo /PJ./., ()t:lJ
Value of all work being performed: s /t.tJ, ~ 0
(value baled on IBC 81Ctlon 108.3 & IRO &ICllon 1011.3)
Electrical Square Footage tt>L>u
Cetalltd Scope and Location of Work:-------
/#J1'1#-L{)ff!.. c-~ : JaJ
Applicant E-Mail:l'f/~~~#H. U"""'
~---------------~-
Project lnfonnatlol"' A q C (.) I -1 (. ' Owner Name: ----1 ~i \.....-\._ __ _
~:~;:!! #,~J~ l;J l!u:ty ~ <=i=l at (170.SZNMO or vl~t
www.tagi-unty.ua/pat11)
(uH additional 1heet if nece1Hry)
For Omee UIO Oaly: -.LJ
Fee Paid: r1£· (g<t
Received From: -------------
cash Check# 33,;2 3 RECEIVED
By Shelley Be/Im at 8:22 am, Apr()O, 2015
CC: Visa I MC Last 4 CC # exp date: __ _
Auth# __ _