HomeMy WebLinkAboutE16-0036.pdf 9 7'R(. 'c-� f31'h1 I 7bepartm.nt of Community Development
t(i!ti)
South Frontage Road West
TOWN OF VAIL * / ,4 Vail, CO 81657
A� X100 Tel: 970-479-2139
�%��'�''�►�:�..t� i.�. www.vailgov.com
I m , - ERMIT APPLICATION
(Separate a•• 'cations are required for Electrical,Alarm, Sprinkler&Public Way)
Project Street Address: ^ (' 15' 1101)
Project#:
UZ J frieJ 0 r ;:;,e,
DRB#: ��► _r
(Number) (Street) / (Suite#) ]�' Q
i Building/Complex Name: F7tr Sk.het. 2 Building Permit#: ('� I
Project Information:� /� Lot#: _Block# Subdivision:
Owner Name: I o tv,•i ,'— (A r •/
Parcel# 210! - 07 / —0/ --C21 Z
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New( ) Addition ( ) Alteration( )
www.eaglecounty.us/patie)
Contractor Information 'Type of Building:
,_,� / �l Single-Family( ) Duplex( ) Multi-Family( )
•
Business Name: I p tun 0 !//G t Commercial( ) Other( )
Business Address: 75 5.4414 Pre y RJ t e -_- -=- —__ .--'
.71
City VG .I State: CO Zip: ' 16 St Work Type: Interior( ) Exterior( ) Both ( )
Contact Name: g-0 hex. /e......%q - - -: - _ -- ---- -
49 Contact Phone: 3 T 4 - 4 t L/ ! Valuation of
Work Included Plans Included Work
Contact E-Mail: K1�$ to !/A r /8-av • G!, vi'-\
I hereby acknowledge that I have read this application,filled out in full the 1 Mechanical ( )Yes ( )No ( )Yes ( )No
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 ( )Yes ( )Vo ( )Yes ( )No
mation and plot plan,to ply with all Town ordinances and state laws,
f/ _
and to build this stru - according t. . town's zoning and subdivision gu. . YeStrG)No �s )No ��.
codes,design revi:approved,I Tonal Building and Residential g �) ( (
Codes and oth,%'inances o •,n applicable thereto.
Total Value of all work being performed: $
X // (value based on IBC Section 109.3&IRC Section 108.3)
Owner/re, 'epresentative Signature(Required)
Detailed Scope and Location of Work:
Applican formation
Add
/J /I `
Applicant Name: /O'✓Pt 0 1f 4I€ do 4 vl /` J K. E/� 7 -A, C (�/
Applicant Phone: 3 6- Of �� off /
Applicant E-Mail: )14 O vet 7 so Li • G C74, t v/ Codes `
Additional Authorized ProjectDox Users
Full Name: • r y 1e, NC/a t .i`4- 414—
E-Mail:
j15 — 033 V2 , .
Full Name:
(us- -•. •- .ecessary)
E-Mail:
I(use additional sheet if necessary)
ll \�/
Date Received: D
For Office Use Only:
Fee
.
Fee Paid: 51. S Ark o \J 2016
Received From:
Cash Check#
CC: Visa/ MC Last 4 CC# exp date: TOWN OF VAIL
Auth #
Rev.2015-Dec