HomeMy WebLinkAboutB15-0382_B15-0382 Application_1443565020.pdf Department of Community Development
75 South Frontage Road
TOWN OF VArf_ Vail, CO 81657
Tel: 970-479-2128
www.vailgov.com
Development Review Coordinator
BUILDING PERMIT APPLICATION
(Separate applications are required for alarm & sprinkler)
Project Street Address: Project#
it 1 1N 4 1nc,t_Ni DRB#
(Number) (Street) (Suite#)
Building Permit#:
Building/Complex Name: 1 11 $. .6 ,1
Contractor Information Lot#: Block# Subdivision:
Business Name
Work Class: New 0 Addition 0 Alteration{ta
Business Address:
City State: Zip Type of Building:
�, Single-Family 0 Duplex 0 Multi-Family 049049Contact Name: SAY-ia`h I Commercial 0 Other 0
Contact Phone 1 —I-1 Co
Contact E-Mail-
Sfo rQ }I , t` .�/v- Work Type: Interior S Exterior a Both 0
LFA /'-'�
I hereby acknowledge that I have read this application,filled out Valuation of
in full the information required,completed an accurate plot plan, Work Included Plans Included Work
and state that all the information as required is correct. I agree to Electrical EYes cNo ADYes QNo 30 a 0
comply with the information and plot plan,to comply with all Town
ordinances and state laws, and to build this structure according to Mechanical IDYes 0)No eYes (No / d0 o
the town's zoning and subdivision codes.design review ap-
proved.International Building and Residential Codes and other Plumbing Yes ( No Yes ONo /01.()
ordina •-s „f the Town applicable thereto.
Building j(es ONo 1Yes QNo 93 Goo
X , Value of all work being performed: $ C
Owner/ ,�`ner's Representative Signature(Required) (value based on IBC Section 109.3&IRC Section 108.3)
Electrical Square Footage
Applicant Information /1 Detailed Scope and Location of Work:
Applicant Name L GYl fir(& i _
Applicant Phone: !? l) — ',■ _ ■ a. . . ►
Applicant E-Mail: I,.14 . .a► ► . • I
Project Informatiorv— Ail-A a J__gA .rte1 4■ +� 4- 1' �•_ '
Owner Name: 1.J0.A S . H e( .St . t�CVS� 41.00 ,-0 ��
Parcel#: 21 b 3 1 21 bg 03 -2_
�+�f 'L
(For Parcel#,contact Eagle County Assessors Office at(970-328-8840 or visit 414(7+tAW
www.ea g 1ec o u nty.u s 1pal ie)
(use additional sheet if necessary)
For Use Date Received:
Fee Paid:
Received From:
Cash Check #
CC: Visa/ MC Last 4 CC # exp date:
Auth #
12-Mar-2012