HomeMy WebLinkAboutB16-0243 transmittal.pdf Department of Community Development
75 South Frontage Road
�;W .< Vail, CO 81657
- Tel:970.479.2128
www.vailgov.com •
Development Review Coordinator
TRANSMITTAL FORM
Use this form when submitting additional information for planning applications or building permits. -
This form is also used for requesting a revision to building permits. A two hour minimum building review
fee of$110 will be charged upon reissuance of the permit.
Application/Permit#(s)information applies
to: - Attention: 0 Revisions
Response to Correction Letter
4 — 1() L( ❑ attached copy of correction letter
O Deferred Submittal
, ()Other
Project Street Address:
1`7q d S/ 6-7-52-M --rg-6I L--- '
(Number) (Street) (Suite#)
Building/Complex Name: G U ( C 1� - 1 Description of Transmittal/List of Changes, Items Attached:
--_...._ LC(rtt ov4 l ,Ccs -i--/-71c
Applicant Information
s(architect,contra tor,owner/owner's rep) CO S r /10 Ci9s(aa/ 5.v"' ���e 7(
=Contact Name: L tJ ___i4e(,,J /V r • r ie) /tieW °o S'- /-'_-_5' POO 7 . .
Address:
i City State: Zip: 1
[Contact Name: t(use additional sheet if necessary)
w
r Contact Phone: Building Permits:
Revised ADDITIONAL Valuations (Labor&Materials)
Contact E-Mail: (DO NOT include original valuation)
I hereby acknowledge that I have read this application,filled out i Building: $ / 0/"0,00 d /
in full the information required,completed an accurate plot plan, f
i and state that all the information as required is correct. I agree to <Plumbing: $ , C1 000
I
comply with the information and plot plan,to comply with all Town
ordinances and state laws, and to build this structure according } ec rica: $ fe
to the town's zoning and subdivision codes, design review ap- '
proved, I ational Building and Residential Codes and other >Mechanical: $ ..%7// 0 0 O
ordinan es f the To appli bre thereto. 5
3 X �./�� 4 .Z��val. Total: $0 —44-61- 1-41-6-----
Owner/Owner's Representative Signature(Required) l.-
? t 1 6.77._ l 0...0. ,...
_. Date Received:
EICEB9
For Office Use Only: JUL- 1
8 2016
Fee Paid: .
Received From: I
Cash Check# TOWN OF VAIL
CC: Visa/MC Last 4 CC# exp.date: �.
Authorization#