HomeMy WebLinkAboutB15-0398_B15-0398 Application_1444334580.pdf i y 'I
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Department of Community Development
75 South Frontage Road
TOWN OF VAIL ' 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#:
`Pata,t-b (Pa+-c-1r1
DRB#:
(Number) (Street) (Suite#)
Building/Complex Name: (-;-t-b ({ atG(/t Building Permit#:
Contractor Information Lot#: Block# Subdivision:
Business Name: Q rn2 Gh�� u C�(
Work Class: New 0 Addition (Qj Alteration 12.,
Business Address: 0, JX. 8( 0
City i. State: Co Zip: 1((031 Type of Building:
Single-Family :4., Duplex( Multi-Family 0
Contact Name: Lo ( ►' uSli,t
Commercial 0 Other 0
Contact Phone: 6h0. Jas• 04.1
Work Type: Interior Exterior() Both ()
Contact E-Mail: (�fit r CA, I''Gtt'�clh mu�v��vti et I .CcNw
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 ()Yes O)No ()Yes ONo
comply with the information and plot plan, to comply with all Town
ordinances and state laws, and to build this structure according to Mechanical ryes O)No ()Yes , lo
the town's zoning and subdivision codes, design review ap-
proved, International Building and Residential Codes and other Plumbing OYes ONo OYes QNo
ordinances of the Town applicable thereto.
Building ()Yes ONo OYes ONo
Air/1 •
I ♦ i..i Value of all work being performed: $"� �(off. CO
Ow Owner's Rep --ottative Signature(Required) (value based on IBC Section 109.3&IRC Section 108.3)
Electrical Square Footage
Applicant Information Detailed scope and Location of Work:
Applicant Name: ,frYlt (ZS £A 2(Xf (`Yta.S- er, b,t,(LvTcY YUU
Applicant Phone: ( e_360A-61,-LIA
Applicant E-Mail:
Project Information
Owner Name: L000,v' f'Yll TI�,L-S�
Parcel#: oZ(b( - (:)(9&- D( -fll'3
(For Parcel#,contact Eagle County Assessors Office at(970.328-8640 or visit
www.eaglecounty.us/patie)
(use additional sheet if necessary)
For Office Use Only:
Date Received:
Fee Paid:
Received From:
Cash Check #
CC: Visa / MC Last 4 CC# exp date:
Auth #
•
12-Mar-2012