HomeMy WebLinkAboutB16-0497 ApplicationTOWN 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 Address: D \. O i..fif.q ~ (])i_,,J{V\DJ ;.JS Dl'-J 7A-
(Number) (Street) (Suite#)
Building/Complex Name:-------------
Project Information: <Oc}L// o c::A NI y -r-7)_, ~
Owner Name: ~_:>lfb lU/:...-117ml l { /C-'U-:t__
Project#:------------------
DRB#: ______ ~~----------
Building Permit#: __ '}5_· _{_tJ_'--_0_L{~l(~' ·1-r---
Lot#: Block# __ Subdivision: _______ _
' Parcel # d I 6 / I~ ;;i__ /I a I 7
(For Parcel#, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Work Class: New ( Addition ( Alteration ( ~~
Contractor Information Type of Building:
?'. ,Single-Family ( ) Duplex ( ) Multi-Famil~
Business Name0:.....:::.. &tl::..,·~----=-""""'-...:u.<J4....+-!...:....:.:...i..!.<:.!....'..r'..,../---J'LL-"'-"'='""'ft. ommercial ( ) Other ( ) __________ _
I , Ai'! Contact Phone: c _.<./
Contact E-Mail:rt>~IJtl/ed~@(!~a/ 4'/I ~T
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 infor-
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
codes, design review api:iroved, I rnational Building and Residential
Codes and :h;.6rd~tes oft Town applicable thereto.
/ -----:> ' x -----·
Applicant Information
(use additional sheet if necessary)
For Office Use Only: ,,..i/-J-~ ,{S-
Fee Paid: _______ "Y ___ J ______ _
Received From: ______________ _
Cash Check# ____ _
CC: Visa / MC Last 4 CC # exp date: __ _
Auth# ___ _
Rev. 2015-Dec
Interior (~~~ior ( . ) Both ( )
Valuation of
Work Included Plans Included Work
Mechanical ( )Yes
Plumbing <//{res
Building ( )Yes
)No
)No
)No
)Yes )No
)Yes )No ;:) _7)0 ~
)Yes )No
, Total Value of all work being performed: $
(value based on IBC Section 109.3 & IRC Section 108.3)
(use additional sheet if necessary)
Date Received:
RECEIVED
DEC 2 0 2016
Town of Vail