HomeMy WebLinkAboutB14-0123 Application.pdf Department of Community Development
75 South Frontage Road
TOWN �F VAlt Vail, CO 81657
Tel: 970-479-2128
www.vailgov.com
Development Review Coordinator
BUILDING PERMIT APPLICATION
(Separate applications are required for alarm & sprinkler)
Project Street Address: Project#:
(Number) (Street) ! (Suite#) DRB#:
BuildinglComplex Name: LG Building Permit#:
Contractor Information Lot#: Block# Subdivision:
Business Name:
Business Address: Work Class: New 0 Addition 0 Alteration cb
City State: Zip: Type of Building:
Single-Family 0 Duplex 0 Multi-Family 1,�
Contact Name: Y
� Commercial 0 Other 0
Contact Phone: . `10 0 cj -1-1 9
Contact E-Mail: 1-CLin Couegi7jU�`6, " 1"y-rfork Type: Interior, Exterior Q 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 BYes O)No ,Yes ONo 1)O C)
comply with the information and plot plan, to comply with all Town
ordinances and state laws, and to build this structure according to MechanicaYes O)No ales ONo . -CSU CJ
the town's zoning and subdivision codes, design review ap-
proved, I 9-national Building and Residential Codes and other Plumbing ayes DNo ,Yes ONo I5—C)C 0
ordinances bf the Town applicable thereto.
Building gkes ONoCOYes ONo
X , • Value of all work being performed: $ IZS'ICO&
Owner/Owner's Represe).tive Signature (Required) (value based on IBC Section 109.3&IRC Section 108.3) 22
Electrical Square Footage J
Applicant Information Detailed Scope and Location of Work:
Applicant Name: e____(1N1 C LIY ` �k-C:V1-00- 4 aka +� l
Applicant Phone: 1“} :'i c�r-� N\
Applicant E-Mail:
Project Information
4-
Owner Name: 1 _ • Ji. f
Parcel#:
(For Parcel#,contact Eagle County Assessors Office at WO- 28-8640 or visit
www.eag lecou nty.usfpatie)
(use additional sheet if necessary)
For Office Use Only:
Fee Paid: Date Received:
Received From:
Cash Check #
CC: Visa/ MC Last 4 CC # exp date:
Auth #
12-Mar-2012