HomeMy WebLinkAboutB16-0243.001 CR transmittal.pdfTOWN OF~ Department of Community Development
75 South Frontage Road
Vail, CO 81657
Tel: 970.479.2139
www.vailgov.com
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: ( ) Revisions
Project Street Address:
!JL/0 S.e.-rA l1A~ \
(Number) (Street) (Suite#)
Building/Complex Name: __..~--=-,,__l,,,_/--=-i....:C..:..........k--=-· ----=-~--S-'·---
Applicant Information
(architect, contractor, owner/owner's rep)
Contact Name: loJJ Rf>. 1 i\J v l \ k
Address: P 0 I l B
City Red L l. re State: co Zip: _t~i l~(a~l-1_,_S"_
Contact Name: _._-'-'I o=J=d=----'-K-"'1>'--'-'1 .v'-'--' "/_._\_( ll _______ _
Contact Phone: _°i_'_'1_0_·_3_7_b_·_!::JJ_· _O_l ______ _
Contact E-Mail: _(i._ec-'-'-:lc;:_· \,_J_)C.:._-t_;_;r_(2,,_<{.-'-..t"'-h----'oo=-._c-=o'-M--'-__
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 information 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 ap-
proved, lnternatio I Building and Residential Codes and other
ordin<;.9\es oft plicable thereto.
x~
Owner/Owner's Representative Signature (Required)
For Office Use Only:
Fee Paid: __________________ _
Received From: ________________ _
Cash _________ Check# _______ _
CC: Visa / MC Last 4 CC # exp. date: ____ _
Authorization # ________________ _
( ) Response to Correction Letter
_attached copy of correction letter
( ) Deferred Submittal
( ) Other __________ _
Description of Transmittal/ List of Changes, Items Attached:
·~1ArJdA-~11u~o Cauec41~h)S
(use additional sheet if necessary)
Building Permits:
Revised ADDITIONAL Valuations (Labor & Materials)
(DO NOT include original valuation)
Building:
Plumbing:
Electrical:
Mechanical:
Total:
Date Received:
$
$
$
$
$
RECEIVED
DFC 2 8 2016
Town of Vail
Ol-Jan-2014