HomeMy WebLinkAboutB17-0099.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)
Proje~ Street Aqgress: y1 3. r~~ °£.p.
(Number) (Street) (Suite#)
Building/Complex Name: N'll!Ju.lr).,\'4 ~ lC\N
Project lnformationL· 17 XA 1 1 (\
Owner Name: · µ , Ak\L~ i...v-'--
Parcel# ZlD \ -Ofi> 1--&1-~ \4
(For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Contractor Information (\
Business Name: ~\ ~lJ,£ l:.cN'Sr~UL""'D 1\ J.
Business Address:?~ l>O(( Cfl/. {
City r A; l-1 \S State: e... t) Zip: € ( lo5 I
Contact Na::J\Jl~ir= tlliG.14 ::t:L-'E
Project#:------------------
ORB#: _________________ _
Building Permit#: __ b--=_._1~7_ ....... _0_0_1_~~·--
Lot#: Block# __ Subdivision:--------
Work Class: New ( 0) Addition ( 0) Alteration (@)
Type of Building:
Single-Family (0) Duplex (0) Multi-Family(@)
Commercial (0) Other (0) _________ _
Work Type: Interior(®) Exterior (Q) Both (Q)
Contact Phone: 4:t-D -~'{ 3 -Z. ~ 2-b
contact E-Mail:~e.M lee o l\.<l.["U..c.t;of\. Q..~M~' \ .~ Work Included Plans Included
Valuation of
Work
(i!))Yes (QNo (QYes
(@)Yes (0)No (QYes
f/J)Yes (QNo (QYes
(QNoQ·~~ ,bb
(QNo 1!:>:,~~ .-
(Q)No 25011){)t) .-
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
Codes and other ordinances of the To ap licable thereto.
Mechanical
Plumbing
Building
Total Value of all work being performed: $ 2..,£-,(j 1 {)Qb. o'O'
(value based on IBC Section 109.3 & IRC Section 108.3) '
O ner/Owner's Representative Signature (Required) Detailed Scope and-Lo~~ti~~-;fWo;k:------·· ··-· ---'"-·
Applicant Information ~ ~ \c I t'=-
1 'J 8:k'-Ne.# ~.y,~~ J":i~'l>l-l'i s.. ·
Applicant Name: kl sA \! \~ \y,(L t: ~ tA ~
Applicant Phone: 8 5" B -Db L.-L.{3' L\.3~ ~\.-t:IS.E;T" ~]) ~~
Applicant E-Mail: \w'ul1.,\\~~ic:\fcC~~f1>·'"'t~ .u-;, .J> ~ LA"Tl~ ,
Additional Authorized ProjectDox Users
Full Name: ------------------
E-Mail: ___________________ _
Full Name: ------------------
E-Mail: ___________________ _
(use additional sheet if necessary)
For Of~ce Use Only: 1 ( !/) 8 (]
Fee Paid: / '-I l!:::f_ , -+
Received From: ______________ _
Cash Check# ____ _
CC: Visa / MC Last 4 CC # exp date: __ _
Auth# ___ _
Rev. 2015-Dec
(use additional sheet if necessary)
Date Received:
RECEIVED
APR 1 0 2017
Town of Vail