HomeMy WebLinkAboutB16-0280.pdfDepartment of Community Development
75 South Frontage Road West
Vail,CO 81657
Tel:970-479-2139
www.vailgov.com
BUILDING PERMIT APPLICATION
(Separate applications are required for Electrical,Alarm,Sprinkler &Public Way)
Project Street ~ttS (\.I J?-h"-l-G
(Number)(Street)(Suite #)
Building/Complex Name:'--r~~"",,-~Pcvli'S
Project#:_
DRB#:_
IiWork Class:New (0)Addition (0)Alteration~)i
I !t·-··"--·-·~,.·'·~·--~-'·~..~·~·-----------·--_····--··1.~Type of Building:!Contractor lntormatton .-t-~!l'V<,I.•\.'..-\'"V'-C-.lSingle-Family (0)Duplex (0)Multi-Family (\.0\)!
Business Name:f-\-\f \~.p4..i \011\3+~vd~!Commercial (0)Other (0),
Business Address:%80 \\-\tuy te J "5UL-\e.;;l{3 ~=""=:.....--=---"=,==="-=.::::=""-==."'=====''''.'''':'-=''-===---d
\'7 i :
City Prvo 0 State:t.D Zip:j?IG '?-o IWork Type:Interior (0)Exterior (C~Both (~I
Contact Name:\V\-~eA..v MC£~!,,-,~•.-.--~--.~_x._·-=~-'-'-----1
Contact Phone:Q10-3,G -'0G &-\"Valuation of I
/"t nQ j Work Included Plans Included Work I
Contact E-Mail:\'Y'(V'\C'-'v'""\:=;JUf~0\?G\::>iA.~\cl.'\"::J .,""*.
Iherebyacknowledgethat Ihave readthis application,filled out in full the IMechanical O)Yes ONo (aVes (aNo IPc')0 ·1
informationrequired,completed an accurateplot plan.and statethat all !6theinformationasrequirediscorrect.Iagreeto complywith the infor-IPlumbing O)Ves «(»No (C":}Yes (ON07,()DO'I 0mationa~dpl~t plan,to comply~th all Townordinan~and stat~1~':Vs,i .J._'-"--'-1 i
and to build this structureaccording~othe town's zorunqand suodivlslon ,..r-.r=;a a ~c-OCO.,des.,designr.ev,.iew ap.proved,InternationalBuildingandResidential !.Building t'-l)Yes t'-l)No (.Yes (No I 'r~~~y~ttZdotrpr~J'of the:0 plicablethereto.II~otal v:~:~::~bein9 p:=:~~g~~0 0 'I~
)(I fa ·W/".(value based on IBC Section 109.3 &IRC Section 108.3)I ,I
Owner/Owner's Representative Signature (Required)1 Detailed Scope and Location of Work:!
Applicant Information /""".",I
Applicant Name:<:7elf{CL74t\l b _1------------------
Applicant Phone:""'f"-C6=~::"'-----'-F!Sl:....;'(9..:..::-:...--...::tJ::..:~;:;:;...:.6~(J~~__+
Applicant E-Mail:-:k::::'-+'~---!..L-L-\:"""",,-=-C,;;;"..j'"'~iU.43"':·91S_·!5.'t..~::!-;..=:....:...i-------------------
"-IAdditionalAuthorize;pr~?x Uo 1--------------------
Full Name:m r::[t)-f i:!...JJILGf'S ,!
E-Mail f?h 'Of l~&eoorm+ndj _
Full Name..11 •I (useadditionalsheet if necessary)
E·Mail:'j
(0"addrn,",',heot IT"'~"''Y)I .r-;;,:~Received:
For Office Use Only:1'1
Fee Paid:--------t---------Received From:,_
Cash Check #_
ec:Visa I Me Last 4 ee #exp date:_
Auth#_
Project Information:
Owner Name:~Z\tL Go./\o'~4~yV\.~+V\(\.t:'h ~\l;fD
Parcel #Q.\0 \\d-.~,3 DO '-\
(For Parcel #,contact Eagle County Assessors Office at (970)328-8640or visit
www.eaglecounty.us/patle)
Lot#:Block #__Subdivision:_
Building Permit#:_
Rev.2015-Dec