HomeMy WebLinkAboutAdler transmittal.pdf Department of Community Development
75 South Frontage Road
TOWN OF VAIL ' Vail, CO 81657
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSMITTAL FORM
Use this form when submitting additional information for planning applications or 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.
Application/Permit#(s)information applies
to: Attention: Revisions
�I b315 p1 ten ?e Vt evVfl attached copy of correction letter
Q Deferred Submittal
0 Other
Project Street Address:
502-0 Mai n 50y-e_ L F-2- -
(Number) (Street) `J" (Suite_- #)f
•
Building/Complex Name: 50Y 43 er Lek._ eaftlu��SDescription of Transmittal/List of Changes, Items Attached:
Applicant Information U I� � do Or)
(architect,contractor,owner/owner's rep) I ;9)41 ier—tA— el //lei 6-r
Contact Name: 0 P- `I �J� w i W CfrA j
�1ec . l rlC9.9C.
Address: (.0.(4
City State: Zip: `�Ci i i_(,011r
Contact Name: Y (AJ l (use additidnal lslleet if necessary)
Contact Phone: 'MD 5 W Building Permits:
r����oi_ i)� 11 Revised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail: lc%__ al (DO NOT Include original valuation)
I hereby acknowledge that I have read this application,filled out Building: $
in full the information required,completed an accurate plot plan,
and state that all the information as required is correct. I agree to Plumbing: $
comply with the information and plot plan,to comply with all Town
ordinances and state laws, and to build this structure according Electrical: $
to the town's zoning and subdivision codes, design review ap-
proved,International Building and Residential Codes and other Mechanical: $
ordin of the Town applicable thereto.
X (LA-'----s• Total: $0
Owner/0 er's R esentative Signature(Required)
Date Received:
For Office Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp.date:
Authorization #