HomeMy WebLinkAboutB15-0243 Test & Balance Transmittal.pdfTOWllOF~ Department of Community Development
75 South Frontage Road
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: QRevisions O Response to Correction Letter
n_attached copy of correction letter 0 Deferred Submittal QOther __________ _
i Project Street Address:
/~I ~ .M-:vt -;r:-~u;.. (-r eMt)
(Number) (Street) (Suite#)
Building/C.omplex Name: _\¥-/ ...... V"--'-r>1i___.L, _______ _
Applicant Information
(architect, contractor, owner/owner's rep)
Contact Name: tQ € Jh h ~RYI
Address:~< )I/, GKc.IY fi&JJr. 4W
City c_t)(v 5 ~S· State:{./) Zip: i?ll'lb 3
. Contact Name: ):::>q,\e.. 2 ~
Contact Phone: 1J'f"" L\q I-<?tf~q
Contact E-Mail: Zz<'...rr~ @ ~e...j~. <::.Pill.
I hereby acknowledge that I have read this application, filled out
in full the information required, completed an accurate plot plan,
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
ordinances and state laws, and to build this structure according
to the town's zoning and subdivision codes, design review ap-
proved, In rnational Building and Residential Codes and other
ordinan of the wn · thereto.
X.~~~~~~~~~~~~~~
owner towner s Representative Signature (Required)
For Office Use Only:
Fee Paid:-----------------
Received From:----------------
Cash ________ Check# ______ _
CC: Visa I MC Last 4 CC # exp. date: ----
Authorization#----------------
Description of Transmittal/ List of Changes, Items Attached:
~~ 1 -:&l@c. ..... ~1-{}y '4T i:-ea~
(use additional sheet if necessary)
Building Permits:
Revised ADDITIONAL Valuations (Labor & Materials)
(DO NOT include original valuation)
·Building: $
Plumbing: $
Electrical: $
· Mechanical: $
Total: $0
Date Received:
TOWN OF VAIL