HomeMy WebLinkAboutB16-0495_application_1481657760.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_~c;fdress: iJ=-1
o ne<' Vfu' &~
(Number) (Street)
Building/Complex Name: fuv ~St"">4S (Suite#)
~6L"f
· Project Information: ,/\ ·-\ > 1~
Owner Name: £;:.JC V N j _ /==/~::::~= t
Parcel # ~ \Q I 0 J I J. "<..DO \
(For Parcel#, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Project#: _________________ _
Building Permit#: ______________ _
Lot#: Block# __ Subdivision: _______ _
Work Class: New ( Addition ( Alteration (/'}
Contractor Information Type of Building:
~ . \ _J /2.... . ( \ ~ Single-Family ( ) Duplex ( ) Multi-Family (
Business Name: tfa¥Y ,.\I\ 'f{'(l;.,r\:I... L J ~11W) ~I ~mmercial (/) Other ( ) __________ _
Business Address: f. 0 · ~ l[..L"'") -··· - -·-·---J ------
u2 Zip: C6 I (,,~ Work Type: Interior v ) Exterior ( ) Both ( )
Contact Phone: -.l.....L..:::::......--'-"i::::>,..__-'--1-"..<.-jf----------
. Contact E-Mail: ~w.h'tlaAk~h> i\lb/1>(! .. AA-.l
I hereby acknowledge that I have read this application, filled out in full the
information required , completed an accurate plot plan, and state that all
the information as required is correct. I agree to comply with the infor-
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
codes, design review approved, International Building and Residential
Cod an other or ·n nc s of the Town applicable thereto.
Signature (Required)
Applicant lnformatio:J ~
Applicant Name: ~ \.(_,,'../._ L \{ k1
Applicant Phone:1~~1--)
Applicant E-Mail: 0:AAO i/\J:~j t~ . .l e.-, '1e'-f
Additional Authorized ProjectDox Users
Full Name: -------------------
E-Mail: ____________________ _
Full Name: -------------------
E-Mail: ___________________ _
(use additional sheet if necessary)
For Office Use Only:
Fee Paid: ________________ _
Received From: ______________ _
Cash Check # ____ _
CC: Visa I MC Last 4 CC # ___ _ exp date: ___ _
Auth # ___ _
Rev. 2015-Dec
Valuation of
Work Included Plans Included Work
Mechanical )Yes )No )Yes )No
Plumbing )Yes )No )Yes )No
Building (/)Yes )No (/)Yes )NJ>l-)c53 -
I
Total Value of all work being performed: $ / ZCP -
(value based on IBC Section 109.3 & IRC Section 108.3)
(use additional sheet if necessary)
' Date Received: RECEIVED
DEC 0 8 2016
Town of Vail