HomeMy WebLinkAboutB16-0229.pdf Department of Community Development
75 South Frontage Road West
TOWN OF n 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 Address: rx Project#:
(Number) (Street) (Suite#) DRB#:
Building/Complex Name: NIA Building Permit#:
Project Information: ILot#: Block# Subdivision:
Owner Name: E)L17 ( o"e i/�y/I rc e L)
Parcel#
(For Parcel#,contact Eagle County Assessors Office at(970)328-8840 or visit Work Class: New(✓) Addition ( ) Alteration ( )
www.eagl ecounty.uslpatie)
Contractor Information Type of Building:
1 / Single-Family(✓) Duplex( ) Multi-Family( )
Business Name: (.71 � L AN11v1 lit)56 e01-054, �f�C Commercial ( ) Other( )
Business Address: Li toi p PPr- LW. - — - -
City ULZ1 State: m O Zip: 7y I65 7 Work Type: Interior( ) Exterior( ) Both (v)--
Contact Name: Y r ELS ( t wi..l 1,93
Contact Phone: y) 2- 376 Valuation of
Work Included Plans Included Work
Contact E-Mail: layo )re)qi1 c` . {_co, / 1�/
I hereby acknowledge that I have read this application,filled out in full the Mechanical (✓Yes ( )No ( )Yes (i/ tOff:C)No VS°
information required,completed an accurate plot plan, and state that ails
the information as required is correct. I agree to comply with the infor- Plumbing (✓SYes ( )No ( )Yes (✓f NolO��
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 Buildinges )No es )No G�5 Q,
codes, design review approved,International Building and Residential (� ( ( ( f Y
Codes and other ordinances of the Town applicable thereto. p r r�` r fl
X Total Value of all work beingperformed: $ ! 0! 0i0t/
ry (value based on IBC Section 109.3&IRC Section 108.3) /�
Owner/Own s Representative Signature(Required) Detailed Scope and Location of Work: 0e/vv 7 Eci5rw-Jc 7 /k"
Applicant Information 4/`
Applicant Name: 6-y-e pm HA1 n 1G S f //
Applicant Phone: y 70 ?7�(a ��// fJ. b viA/6 s ue e_ y_.a r real
•
Applicant E-Mail: To,K1,r� gc7-6? 6'M t 1.
Additional Authorized ProjectDox Users
Full Name:
E-Mail:
Full Name: (use additional sheet if necessary)
E-Mail:
(use additional sheet if necessary)
Date Received:
For Office Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa / MC Last 4 CC# exp date:
Auth #
Rev. 2015-Dec