HomeMy WebLinkAboutB17-0042.PDFIOWf,I OF
Department of Community Development
75 South Frontage Road West
Vait, CO 81657
Tel: 970-479-2139
www.vailgov,com
Project Street Address: A<t,/6 r'/a,n Go"e-ftL(Number) (Street) (Suite #)
B u i rd i n s/com prc* n^^", $ra11D t i,L 16t, t n A t yn" 5
Proiect Information:,
owner n"^", (7rtta*e Ee4ac?trncnf
Parcel #
(For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit
w,eaglecounty. us/patie)
Contractor lnform ation
Business Name:
BusinessAddress: /o 0or 4'/37
cfty *+1./OY1 srate.CO zip.6/bzo work rype:lnterror (Q)) Exterior (O goth (C)
-o/32,LiVa € oyrt
I hereby acknovvledge that I have read this
information required, completed an accurale plot plan, and state that all
the information as required is correct. I agree to comply with the irrfor-
mation and plot plan, to comply wjth ali Tovrn 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
and other ordinances of the Town applicable thereto
Vt
Representative Signature (Required)
Applicant Name:
Applicant Phone:
Applicant E-Mail:
l]a'nor Cvon'e-
Additional Authorized ProjectDox Users
Full Name.
Contact Name:
Contact Phone:
Contact E-Mail:
BUILDING PHRMIT APPLICATION
(Separate application:i are requtred for Electrical, Alarm, Sprinkler & public Way)
q
Project #
DRB #
Building Permit #
Lot #. Block # Subdivrsion
Work Class: ruew (O) Addition (Q;) Atteration (fr)
Type of Building:
Single-Family (C) Ouplex 1C;; utrtti-ramilv (ClZcommercial (C;) otner (Cl
Work lncluded
Valuation of
Plans Included Work
filled out in full the Mechanicat C;ty". fC)No lC)ves fCNo
Plumbing
Building
(-,)Yes te)ruo (OYes (CNo
fi:lves (C)no (Cves (CNo
- Total V:ilue of all work berng performeo: ,5OA Xn A
P,.t*,|"1f*lJe based cr l3C Sec:icr'c9 -? & IRC sect,on i08 -1)
Detailed Scope and Location of Work _
6c,
Applicant lnformation
Full Name
(use additional sheet if necessary)
1i-se additional sire.t if n€cessary)
Date Received:
E-Mail
For Office Use OnlY:
Fee Paid:
Received From:
cach Check #
CC: Visa / MC Last 4 CC #
Auth #
own irfcr'u^P uu!\,,
Rev.2(r1s-Dec