HomeMy WebLinkAboutB16-0426.pdf Department of Community Development
t°i:1)
75 South Frontage Road West
TOWN OF Vail,CO 81657
l TeL 970-479-2139
www.vailgov.com
BUILDING PERMIT APPLICATION
(Separate applications are required for Electrical,Alarm, Sprinkler&Public Way)
Project Street Address:
54 Project#:
(Number) (Street) (Suite#) DRB#:
Building/Complex Name: / Building Permit#:
Project Information: k61/ /'1-- Lot#: Block# Subdivision:
Owner Name: /2aee-/1/. ip/2Z/ , h71-�r�4/0-e-
Parcel# P.103%if30%���
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(C`) Addition((.ti,) Alteration(K.)
www.eaglecounty.usipatie)
Contractor Information Type of Building:yy
Single-Family(,,���) Duplex(t -) Multi-Family(C)
Business Name: 09/ /9/1V7 V 7,11'7 - Commercial(C) Other(I)
Business Address: e
City G�'/. State: c Zip: K.0 Work Type: Interior(C) Exterior(C) Both
Contact Name: /9/5"7-6 _ G7O
Contact Phone: (.o) O /OI Valuation of
Work Included Plans Included Work
Contact E-Mail: //a/let/ G�'r -
��I zvlv��vt /fr.C- ���`���i� 1
h
I hereby acknowledge that I have read this application,filled out in full the--Mechanical ( )Yes ( ()No )Yes ( No G�
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 (q)Yes (C)No (C)Yes (( )No
mation and plot plan,to comply with all Town ordinances and state laws,
and to build this structure accordin• to the town's zoning and subdivision /�� / �j'�1f
codes,design review approved rternational Building and Residential Building ty )Yes (C)No (r)Yes (C)No ` <
Codes and other ordinances . ' e Town applicable thereto.
Total Value of all work being performed: $ ��/ 9-0
X (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 �,�(. /
(i;/I �c,itieli d#7 . A 'i( L,„'dd / ,k/e(f///154ti(/
Applicant Name:
Applicant Phone: N14/ 1,Jtfed0W/ /� � ,!
Applicant E-Mail: Wit I(. //1 Aegr?rvx,,ivi" (/)
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