HomeMy WebLinkAboutB16-0243.001 transmittal.pdfDepartment of Cominunity Development
75 South Frontage Road
Vail, CO 81657
Tel: 970.479.2128 ·
www.vailgov.com
Development Review Coordinator
TRANSMITTAL FORM
Use this form when submitting additional information for pfanning applications or building permits. ·
This form is afso used for requesting a revision to building permits. A two hour minimum building review
fee of$110will be charged upon reissuance ofthe permit
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, (jqther __________ _
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j Project Street Address: __.,.. / I 171-o &1~1)!Jj!) 111141 .
~ (Number) (Street) (Suite#} j I Building/Complex Name: II !ou10k de. O' 1/) t:IUD e I Description of Transmittal/ Ust of Changes, ftems Attached:
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!ctty \/A~/ state: Co. Zip: f'/6r2f f--------------~ :~
icontactName: ~----------------------------------------~(use additional sheet if necesspry)
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} Contact Phone: _ __,-L"""----J..L..L..J.o<..--'""--1--"'--------
i <'"4'!7 r.-L._ a !ffl/1)-!' co··/JA/JiRevised~DDITION~L.Valuation~{Labor&Materials) ! l Contact E-Mail: v.tJL---ftL.0/)jOT IL ~ i:g, !Z!L ~ /N'V! l (DO NOT mclude ongmal valuation} l r -~ ~
! I hereby acknowledge that I have read this application, filled out I Building: $ I
in full the information required, completed an accurate plot pfan, i i
and state that alt the information as required is correct. I agree to ) Plumbing: $ ~
comply with the information and plot plan, to comply with all Town i. · f
ordinances and state laws, and to butld this structure according \ Electricaf: $ t
to the town's zoning and subdivision codes, design review ap-.1 j
proved rnational Bui! ing an Residentiaf Codes and other i Mechanical: $ ~
ordin c of the Tow pplic e thereto. j [ j X ..) ii Total: $ 0 I
I Owner/Owner's Representative Signature (Required) ~-·········· .. ··-··········································································-······-·········-·········-···-······························-····················' ~
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For Office Use Only:
Fee Paid: __________________ _
Received From:-----------------
Cash _________ Check# _______ _ TOWN OF VAl~~" .. J
CC: Visa/ MC Last 4 CC# exp, date: ____ _