HomeMy WebLinkAboutB16-0377.pdf Department of Community Development
75 South Frontage Road West
TOWN OF VAIL# 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: Project#:
2335 Bald Mtn RD B10
(Number) (Street) `� (Suite#) DRB#
Building/Complex Name: �M . y O1,0t1'hQ rt Building Permit#
Project Information: Lot#. Block# Subdivision:
Owner Name:;'(�I(re.6('(1cCnlli�c-, I.\
r�(1rti
Parcel#2101-033-02010
(For Parcel 0,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(p) Addition(0) Alteration(CD)
www.eaglecounty.uslpalie) _
Contractor Information Type of Building:
Jerry SibleyPlumbing, Inc. Single-Family(0) Duplex O) Multi-Family(0)
Business Name:
Commercial(0) Other(0)
Business Address: PO Box 340
City Mintum State: CO zip; 81645 Work Type: Interior(®) Exterior(C) Both(C.)
Contact Name: Kristena Wyatt
Contact Phone: 970-827-5736 Valuation of
Contact E-Mail: jspinc@vail.net Work Included Plans Included Work
I hereby acknowledge that I have read this application,filled out in full the Mechanical ())Yes (G)No (C)Yes (C)No 21,000.00
information required,completed an accurate plot plan,and state that all
the Information as required Is correct, I agree to comply with the infor- Plumbing (0)Yes (C)No (C)Yes ((')No
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 Building (D)Yes (0)No (C)Yes Na
codes,design review approved,International Building and Residential t�} (C)
Co es and other ordinances of the Town applicable thereto. -
X �� � Total Value of all work being performed: $21,000.00
(value based on IBC Section 109,3&IRC Section 108.3)
Owner/Owner's Representative Signature(Required) Detailed Scope and Location of Work
Applicant Information Replace existing boiler and water heater with a Triangle
Applicant Name: Jerry Sibley Plumbing, Inc
Applicant Phone:
970-827-5736 Tube SOLO110 boielr&TT Smart60 indirect water
Applicant E-Mail: jspinc@vail.net heater
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