HomeMy WebLinkAboutOTC15-0013_OTC15-0013_1427749560.pdf •
Department of Community Development
75 South Frontage Road
N TOWN OF VAIL Vail, CO 81657
Tel: 974-479-2128
www.vailgov.com
= Development Review Coordinator
BUILDING PERMIT APPLICATION
1 (Separate applications are required for alarm & sprinkler)
Project Street Address: Project#:
5128 Grouse Ln A
DRB#:
(Number) (Street) (Suite#)
Building Permit#:
Building/Complex Name:
Contractor Information Lot#: Block# Subdivision:
Business Name: Colorado Delta Mechanical
Business Address: 6056 E Baseline Rd # 155 Work Class: New a Addition (0j Alteration (0
City Mesa State: AZ Zip: 85206 Type of Building:
Contact Name:
Leslie Single-Family 0 Duplex 0 Multi-Family 0
Commercial 0 Other 0
Contact Phone 866-692-5273
Contact E-Mail: copermits@deltamechanical.com Work Type: Interior C) Exterior 0 Both 0
I hereby acknowledge that I have read this application,filled out Valuation of
in full the information required,completed an accurate plot plan, Work Included Plans Included Work
and state that all the information as required is correct. I agree to Electrical °Yes Q)No 0Yes (No
comply with the information and plot plan, to comply with all Town
ordinances and state laws, and to build this structure according to Mechanical °Yes O)No rYes ONo
the town's zoning and subdivision codes, design review ap-
proved, International Building and Residential Codes and other Plumbing ()Yes ONo ()Yes ONo 804.28
ordinances of the Town applicable thereto.
Building °Yes ONo i°Yes QjNo
X L141/e/r-
Value of all work being performed: $ 804.28
Owner/Owner's RepresentSignature (Required) (value based on IBC Section 109.3&IRC Section 109.3)
Electrical Square Footage
Applicant Information Detailed Scope and Location of Work: Replace 50 gallon
Applicant Name: Leslie electric water heater 4500 Watts inside of the house.
Applicant Phone: 866-692-5273 Disconnect/Reconnect
Applicant E-Mail: copermits@deltamechanical.com
Project Information
Owner Name: Amy McGlynn
Parcel#: 2099-182-12-009
(For Parcel#,contact Eagle County Assessors Office at(970-328-8640 or visit
www.eag I ecou nty.uslpatie)
(use additional sheet if necessary)
Fur Office Use.Only: Date Received:
Fee Paid:
Received From;
Cash Check#
CC: Visa / MC Last 4 CC # exp date:
Auth #
12-Mau-2012