HomeMy WebLinkAboutB15-0223_B15-0223 fee adjustment application_1437688500.pdfTOWN OF~ Department of Community Development
75 South Frontage Road
Vail, CO 81657
Tel: 970-479-2128
www.vailgov.com
Development Review Coordinator
BUILDING PERMIT APPLICATION
(Separate applications are required for alarm & sprinkler)
.-~~~~~=-~~~~~~~~....,.....,..--~~~~--. 4f d-Project#: £PD' 15. -033 <-j Project Street Address:
5123 Black Bear Lane
(Number) (Street) (Suite#)
Building/Complex Name: Howard-Levaggi Remodel
Contractor Information
Business Name: Local Restoration, LLC
Business Address: 1003 Main Street
City Minturn state: _c_o __ Zip: 81645
Contact Name: Jeff Armistead
Contact Phone: 970-471-0618
Contact E-Mail: localrestorationllc@gmail.com
I hereby acknowledge that I have read this application, filled out
in full the information required, completed an accurate plot plan,
and state that all the information as required is 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 and subdivision codes, design review ap-
proved, International Building and Residential Codes and other
ordinances of the Town applicable thereto.
X Tim Howard Digitally signed by Tim Howard
DN: en= Tim Howard. o, ou, emall=thoward@indra.com, c,,,u5
Date: 2015.06.25 15:01:49-06'00'
Owner/Owner's Representative Signature (Required)
Applicant Information
Applicant Name: Tim Howard (Owner)
Applicant Phone: 1-303-918-1882
Applicant E-Mail: thoward@indra.com
Project Information 5123 Bl kB L LLC Owner Name: ac ear ane
Parcel#: 2099-182-25-002
(For Parcel #, contact Eagle County Assessors Office at (970-328-8640 or visit
www.eaglecounty.us/patie)
For Office Use Only:
Fee Paid:-----------------
Received From: ---------------
Cash Check # ___ _
CC: Visa I MC Last 4 CC # ___ _ exp date: __ _
Auth# ___ _
DRB#:--------..,-----....---------
Building Permit#: _8 __ 1 _S_-_O_~_O __ , ... :S...----
Lot#: Block# __ Subdivision:--------
Work Class: New 0 Addition 0 Alteration (®
Type of Building:
Single-Family 0 Duplex 0 Multi-Family 0
Commercial 0 Other @Split Level Residential Condo
Work Type: Interior(!) Exterior 0 Both 0
Valuation of
Work Included Plans Included Work
Electrical (!)Yes Q)No QYes QNo 4500
Mechanical (!}Yes Q)No QYes QNo 1500
Plumbing (!)Yes QNo QYes 0No 5000
Building @Yes QNo QYes QNo 11000
Value of all work being performed: $ 22000
(value based on IBC Section 109.3 & IRC Section 108.3)
Electrical Square Footage 100
Detailed Scope and Location of Work: Demolition of some
interior walls, re-locate some existing electrical,
re-work laundry, shower plumbing, update new bath
cabinetry, tile, flooring, drywall, paint
(use additional sheet if necessary)
Date Received:
TOWN OF~ Received
By Carolyn Godfrey at 8:01 am, Jul 23, 2015
12-Mar-2012