HomeMy WebLinkAboutB15-0085 REV3 Transmittal Department of Community Development
75 South Frontage Road
TOWN OF VAtL Vail, CO 81657
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSMITTAL FORM
Use this form when submitting additional information for planning applications or building permits.
This form is also used for requesting a revision to building permits. A two hour minimum building review
fee of$110 will be charged upon reissuance of the permit.
Application/Permit#(s)information applies
to: Attention: Revisions
0 Response to Correction Letter
*E>1CD()0,5 n attached copy of correction letter
Q Deferred Submittal
0 Other
I Project Street Address:
$831 xt Ke)-
(Number) (Street) (Suite#) _
Building/Complex Name: Description of Transmittal/List of Changes, Items Attached:
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Applicant Information /tp��p� �"„�p
LA) I r.
(architect,contractor,owner/owner's rep) ��� �`
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Contact Name:
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Address: ► •+�.S131( ���Z -vvv,tOc-. " ' Z (PcLt)
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City ,vON State: GO Zip: S1 GOZ.O
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Contact Name: M(1r.g (use additional sheet if necessary)
Contact Phone: 1:104 37 Ca ' Co43
Building Permits:
St,JL?S�GvvtGtlRevised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail:IMl .�� (DO NOT include original valuation)
I hereby acknowledge that I have read this application,filled out Building: $
in full the information required,completed an accurate plot plan,
and state that all the information as required is correct. I agree to Plumbing: $
comply with the information and plot plan,to comply with all Town
ordinances and state laws, a • : build this structure according Electrical: $
to the town's z•-.ng an. :••div::on codes, design review ap-
1 proved,Inon-,:uildin• :nd Residential Codes and other Mechanical: $
ordinan-- oft moo •licable thereto. (`
X �L �iI� 4gp_ctd1a"f o `Total: $0
'Owner/Ow A eprareSiignature(Required)
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J I Date Received:
For Office Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp.date:
Authorization#