HomeMy WebLinkAboutB16-0192.pdf Department of Community Development
75 South Frontage Road West
TOWN OF VAIL Vail, CO 81657
Tel: 970-479-2139
t www.vailgov.com
BUILDING PERMIT APPLICATION
(Separate applications are required for Electrical,Alarm, Sprinkler& Public Way)
Proj t Street Address:
it0� Project#:
I _
(Number) (Street) (Suites) ORB#:
Building/Complex Name: wilding Permit#
• Project information' l.nr#-_. Block# ubcfiviaion:
Owner Name: 7theni 1 k Rf,7 •Cre-45
Parcel .. .. ..
i
(For Parcel#,contact Ea., lc County Assessors Office a woli3ZB-ft13.11.0 or vJs It Work Class: New ( ) Addition {X.} Alteration ( )
www.s aglocourity.usYmie)
Contractor Information Type of Building=
Single-Family(r ) Duplex ( ) Multi-Family{ }
Business Name; /i � 1
I - Commercial ( ) '
( ) Other
•
Business Address: �l/1.1.19/13 - E7-4,1?
I City ._-,State; r -_Zip: Gd -r -- .Work Type: Interior( ) Exterior( ) Both (.<"")
-
. Contact Name: W � (,...div., _ .. -. -- .-.,.. , . .
I Contac# Phone; ) _QValuation of
r Work Included Plans Included Work
Contact E-Mail; L_}l rf Irl l R r - ' Y ...- ,
. I hereby acknowledge that I have read this application,filled out in full the Mechanical ( )Yes ( )No ( )Yes ( )No
information required,crompleted an nal rate plot plan,arid State that all •
the Information as required is correct I agree to comply with the infor- Plumbing ( )Yes ( )Nc ( )Yes ( )No 1/5-4
mation 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 a,,..„! i red,[ntemetional Building and Residential Building ( )Yes ( )No { )Yes ( )No _ _
Codes and other ordi .-a of the Town applicable thereto- t — _-. :.-.,.
l if
Total Value of all work being performed: $ . !
I
I _ 1(value based on IBC Sealer 109-3&IRC Section 708.3)
Owner/Owner -epresentative Signature(Required) Detailed Scope and Location of Work;
Applicant Information
Applicant Name: �i � T-.� 1' r'D ' ( +�' C r
/--
Applicant Phone;
_— _ #r - 1r./} .f f rierc
Applicant E-Mail: ! +f1 lilt/10/-07
Additional Authorized ProjectDox Users t O :44
Ful[ Name: i!' N'1I AICH- 1g.'r
E-Mail: - --- i f t O e #af''�.h5 Roc
—
Full Name:
- (use additional sheet if neoessaryf)
I E-Mail;
(use additional sheer if n cassary)
Date Received:
For Office tine Only:
Fee Paid: _
Received From;
Cash Check #
CC: Visa f MC Last 4 CC #_-- -- exp date;
Auth #
Rev-2015-Dec