HomeMy WebLinkAboutB17-0024.002 Transmittal.pdf Department of Community Development
75 South Frontage Road
TOWN OFAAIL 1 Vail, CO 81657
Tel: 970.479.2139
www.vaiigov.com
TRANSMITTAL FORM
Use this form when submitting additional information, changes& inspection reports for building permits.
This form is also used for requesting a revision to building permits. A two hour minimum building review
fee of$110 will be charged upon reissuance of the permit.
Submit this form only to: cdev_submittal@vailgov.com. Deliver paper plans to Community Develop-
ment or upload your revised/corrected plans to the appropriate project in ProjectDox,when requested.
Application/Permit#(s)information applies to: (�"l� —' ooe ���� �.__�_ _____.__.._._�___.�.�_
O Revisions ( ) Response to Correction Letter attached copy of correction letter
O Deferred Submittal 040ther D i_ cd✓v:roe I; ,J,01-N--
Project Street Address:
75/9 7— A! Pr , Description of Transmittal/List of Changes, Items Attached,
J�� _ Indicate changed plan pages:
(Number) (Street) (Suite#) / hi
Building/Complex Name: �.-rs(� Fe wi i/(� �.tMtc.. � 4 hio..-1 Pr:eiC 7,7,,S7
(Ai 2 /,00, __.e el I I 1 ru i
Applicant Information Dr c1( Q,,L ria5 v V- ' J(61014
(architect,contractor,/owner/owner's rep)
Contact Name: crOL,-1 /C'1 vi4 /7-2)
Address: 75 5-0,.,4-1-, .(7,1„,,,,c____ PD Wc.S1--
City (JAI( State: CCS Zip: �`6.7 (use additional sheet if necessary)
Contact Name: 4✓1 / ,...0.
/ Building Permits:
Contact Phone: `�., 3 7' - oq y9' Revised ADDITIONAL Valuations(Labor&Materials)
� (DO NOT include original valuation)
Contact E-Mail: -/C, efi '.t, �./So✓ - Co '✓\ ctt
Building: $ 51 O e
I hereby acknowledge that I have read this application,filled out
in full the information required,completed an accurate plot plan, Plumbing: $
and state that all the information as required is correct. I agree to
comply with the information and plot plan,to comply with all Town Electrical: $
ordinances and state laws, • %d to buil. i s structure according
to the town's zoning and .division o. -s, design review ap- Mechanical: $
proved, International B 'king and,:- - a .des and other
ordinances of the T. '' applicabl- ereto. Total: $
X
Owner/Owner's R:.* - - ive Signature (Required)
Date Received:
21-Apr-2017
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