HomeMy WebLinkAboutB16-0443.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
• (Seoarate applications are required for Electrical, Alarm, Sprinkler&Public Way)
Project Street Address: project#:
gill S 41-- rP.. E- 3
(Number) (Street) (Suite#) DRB ft:
Building/Complex Name: L Building Permit#:
Project Inf rmati rn
( Lot#: Block# Subdivision:
Owner Na e: z��;����1 � 7� rL.e,� �C` +' _- --
Parcel# lO 1 Uff .p? - 7
D00D— _...._._.-
(For Parcel#, lontact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New( ) Addition ( ) Alteration O
www.eaglecou ty.uslpatie)
Contractor nformation Type of Building:Single-Family( ) Duplex( ) Multi-Family( )
Business N me: t kg(A 4 /PV&) 1O P,r�+ Commercial { } Other( )
Business Adress:
City )? rr�• State: co
Zip: 51
(0 3 Wok Type: Interior(X.) Exterior( ) Both ( )
Contact Na e: j,DOar/ Fie OE-et fie
Contact Pho e: 91° ti 7/ --/Z..0.3 Valuation of
l Work Included Plans Included Work
Contact E-M il:J JC✓u Ii-CS k ve4.c5.4.6.- VGt i 1, C,r'`''t---
I hereby ac owledge that! ave read this application,filled out in full the Mechanical ( )Yes ( )No ( )Yes ( )No
information required,compiet d an accurate plot plan, and state that all
the information as required is correct. I agree to comply with the infix- Plumbing (I)Yes ( )No (,,k)Yos ( )No a trus)
mat/on andlot plan,to comely with all Town ordinances and state laws,
and to build his structure ac•ording to the town's zoning and subdivision (1°1)codes, desi review approv-d,liternational Building and Residential Building OYes ( )No (,),....)Yes ( )No 1Dl
Codes and o her ordinances .f the Town applicable thereto. I
Total Value of all work being performed: $ /67 0 ad
X I (value based on IBC Section 109.3&IRC Section 108.3)
Owner/Own lr's Represent ive Signature(Required)
Detailed Scope and Location of Work:
Applicant In ormation
Applicant Na e: Lek •,i- t 1"`� V►+<f i t�� cs PSC l3 h) S ►
Applicant Ph ne: - c-10 J-L
Applicant E- all: �' - G.11C=ii,l-e.'S a ntt"� e� c.,pea_ 1,././ see,-h 1
: r-C1
Additional thorized Pro ectDox 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 I MC Last 4 CC# exp date:
Auth #
Rev.2015-Dec