HomeMy WebLinkAboutB16-0458.pdfTOWN OF~ Department 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)
Project Street A~Glfess: .
26 s= /orCLJ r ' (Number) (Street) (Suite#)
Building/Complex Name: --:-zr,-::zr/)":z~:::E'0J:~7t:-
Project Information:
Owner Name:=---""'""~=='=-........ ~,=---------
Parcel #_...._.='-'"'-"--';;;.....,.r-~-'-'_,;.-""''--'1.....>o""-----
<For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Project#:------------------
ORB#: ______ ___,,=----------.,..--
Building Permit#: __ 13 __ \ _b_-_O __ y...;....._:,r;"""--· <{;-=--
Lot#: Block# __ Subdivision:--------
Work Class: New (C) Addition (CJ) Alteration (C)
Type of Building: ~ Contractor Information . ,0 I / . r r/.-, . Single-Family (C) Duplex~ .... ) Multi-Family (l)
Business Name: ~/U/ri!J/·:,) "'/'YL/VJ·.:4-C Commercial (C) Other(C) __________ _
Business Address: l'i:?O . ~ ? . _ .
City ~ dvnd State: . Co Zip: 5163 2.. Work Type: lnterior~or~h ~
Valuation of
ConractName ?<~ ~
Contact Phone: _ _3__,.-.~_..._7'_,_G......__ .... 2'--'~:'---11 .. ~'""'" ~-"""-3 ______ _
Contact E-Mail: ilim ~/[;,/¥]
I hereby acknowledge that I have read this application, filled out in full the Mechanical
Work Included Plans Included Work
~)No (C)Yes ~ OfocJO, <?
information required, completed an accurate plot plan, and state that all
the information as required is correct. I agree to comply with the infor-Plumbing
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
L')Yes (C)No (l)Yes (l)No
codes, design review ap roved, International Building and Residential 1 Building {°')Yes (l)No (C}Yes (C)No
Codes and other or · es o ap licable thereto.
Applicant Name: -----------------
Applicant Phone:-----------------
Applicant E-Mail:-----------------
Additional Authorized ProjectDox Users
Full Name: -------------------
E-Mail: ___________________ _
Full Name: ------------------
E-Mail: ___________________ _
(use additional sheet if necessary)
For Office Use Only:
Fee Paid:-----------------
Received From: ---------------
Cash Check # ____ _
CC: Visa / MC Last 4 CC # ___ _ exp date: __ _
Auth# ___ _
Rev. 2015-Dec
C'. ,-Oc
Total Value of all work being performed: $ ()5,a:,>6
(value based on IBC Section 109.3 & IRC Section 108.3) 7
50o.J~/f .~
~~C:.?--~ ,k, :;JWs:J
(use additional sheet if necessary)
Date Received:
OCT 2 6 2016