HomeMy WebLinkAboutB16-0133.pdf Department of Community Development
TOWN OF VAIL 75 South Frontage Road West
Vail, CO 81657
Tel: 970-479-2139
BUILDING PERMIT APPLICATION www'vailgov.com
(Separate applications are required for Electrical,Alarm, Sprinkler& Public Way)
Pro'ect Street Address:
•
65-- , �� Project#:
(Number) (Street) �—
DRB#:
Vi' r Q (Suite#)
Building/Complex Name: ( a
Project information: Building Permit#:
Lot#: Block# Subdivision;
Owner Name: IAA I • ii i S
Parcel# 0 ( 0 7(U8
(For Parcel a,contact Eagle County Assessors Office at(970)328-8540 or visit Work Class: New
PParcel
a,con act a Eagle
ww
(,�`) Addition (�`) Alterations
ie)
Contractor Information Type of Building:
Business Name: gyp/ ( f r i/ S Single-Family(C) Duplex((') Multi-Family)
Business Address: / r ê v
Commercial((�) Other(C�.)
,
City `/(_ State: p - /
Zip: Work Type: Interior ni Exterior(r) Both(r)
Contact Name: AR 40 Ar V p tet 1 L
Contact Phone: 6-4.'70 8 d -S.----
Contact E-Mail: • ' a ' eit Work Included Plans Included Valuation of Work
L4 cool
I hereby acknowledge that I have read this application,filled out in full the Mechanical (C)YeSC
information required,completed an accurate plot plan,and state that all ( )No (C)Yes (C)No
the information as required is correct. I agree to comply with the infor-
N.
Town ordnances and state laws,
andmation and to build this lot structure according tol
lan,to comlith allthe own'sizon ng and subdivision Plumbin
9 Y ((—)No( )No (C�)Yes (C)No ����
codes, design review approved,International Building and Residential Building
Codes and other o ' sof the Town applicable thereto. s {�)No Yes (C�)No ____,7(�U
X Total Value of all work being performed: $ a t�(7
(
Own Wn p (value based on IBC Section 109.3&IRC Section 108.3)
resentative Signature(Required)
Applicant Information Detailed Scope and Location of Work:
Applicant Name: • r j�✓t't• !_ Ce &AE ,ck
INELApplicant Phone: (} 4/ • _. (� I
Applicant E-Mail: O• IM L ,
Additional Authorized Projectbox Users A '
Full Name: - —ke sa.� re UPS kW
-
Full I0. /I
E-Mail: ♦ a Q . s • . �l `I5 t1 . ,Ai • /! i `/ I I `_ e'
er
Full Name: A ft,6,16124.41
a�rr( + JL �7S •
E-Mail: O , � (use additional sheet if necessary) d- RJ1lYti1
(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 #
Rev.2015-Dec