HomeMy WebLinkAboutB16-0219.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 Stree~dress: ~ ..L _ 1 Project#: 110 J!oTtf(o rAu:.n 41 IS: __..._'4S_hJO __ J6-~0-l-~-,-,-~p ........
(Number) (Street) .-;-i DRB #: ---~:........::::=----'"---"---v;;;;.._ __ J_M __ -
Building/Complex Name~,;_o~fA...;..~.;_O.;_'__;_: 11J;4~fC=:.!.1....::::=::u.or.o~:.l.!Jl..:..=:...1..pBuilding Permit#: ·-g J6 ~OJ-\ er
Project Information: H -. • \ Lot#: Block# __ Subdivision:--------
Owner Name: __ ___..__frt.J_..___·D_' _6-=-l_V _ ____,,,,.......--
Parcel # Q. I 01 ob3 l q 61 ~' .___ ____________ __.
(For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Work Class: New((';) Addition((';) Alteration((';)
Type of Building:
Single-Family (l) Duplex(<'"") Multi-Family (C) Contractor lnformat!on • • • r,
:::::::: ::;~~~~~~' ~~.j.-'-'"c!. Commercial (n) Other(C) _________ _
city £1ude state: CO Zip: ~?14d /
Contact Name: '\/.ANC.e C!_AfUU::JJ/
Contact Phone: 910 ago S:J..~9
Work Type:
Contact E-Mail: SyNthe f:Jc :Sj DiN<JS ~118d. (J::)/V/ ,
I hereby acknowledge that I have read this applicatio; ~d out in full the 1 Mechanical
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 codes, design revie pproved, International Building and Residential Building
Interior (C') Exterior ((') Both ((';)
Valuation of
Work Included Plans Included Work
O)Yes (C,No (C)Yes (\)No
Ci) Yes (0)No ({')Yes ((';,No
($)Yes (C)No (C)Yes (C)No
Codes and other i:linances of the applicable the to.
Total Value of all work being performed: $ ~QC()"°
(value based on IBC Section 109.3 & IRC Section 108.3)
Owner's Representative Signature (Requir Detailed Scope and Location of Work: /?eM011e AND
Applicant Information J t 1{e.1.w11ee tJt.1 ea DllmAaro £. r. £S1 Applicant Name: 7, iflA~ 7 fu -'
Applicant Phone:---------------fj-tJ 0 oO sua 5n e, c2 x lo s as I
Applicant E-Mail: 'f?.epltU! e .SAMe -r?l/l .SAMe ,lJoti/c. is
Additional Authorized ProjectDox Users loooreo OJ) Noll.th eleVRT{OA( a-t-
Full Name: ._M ..... 9........,IN~_,eAJ-= ..... fa ...... :J..._------------
E-Mail: ___________________ _
Full Name: ------------------(use additional sheet if necessary)
E-Mail: ___________________ _
(use additional sheet if necessary)
Date Received:
For Office Use Only: 4t 6 (? · Cf
Fee Paid: _____ ._:p~~_D_' ___ _
Received From: ______________ _
Cash Check# ____ _
CC: Visa I MC Last 4 CC # ___ _ exp date: __ _ TOWN OFVA\L
Auth# ___ _
Rev. 2015-Dec