HomeMy WebLinkAboutB16-0067.pdfDepartment of Community Development
75 South Frontage Road West
Vail, CO 81657
Tel: 970-479-2139
www.vailgov.com
BUILDING PERMIT APPLICATION
(Separate applications are required for Electrical, Alarm, Sprinkler & Public Way)
Project Street Address:
;..05¥; Sv-o~d lu--~
(Number) (Street) (Suite#)
Building/Complex Name:-------------
Project Information: .
0wner Name, -£.l~'v.L?£Jl-u~
Parcel# "'2.Jt> 1-toz-OJ -ooi-_
(For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patle)
Contractor Information
Business Name: ~\iw, P~ ft.le, 1N •
Bus;ne~Address' P.V.1$cl< 10'0 ~
City t:f.V d t) . State: L () Zip: 'd/ 6"2-U
Contact Name: Ja1b1a.c-_,, ]3u~
Contact Phone: 'fl() · 37() ·· T~ S I
Project#:
DRB #: J5tf3, & -(20 7 d--_ ~s
Building Permit#: 5 \ \e=: C:() LO ·7
Lot#: Block# __ Subdivision:--------
Work Class: New <O> Addition <0> Alteration e)
Type of Building:
Single-Family 0 Duplex(), Multi-Family(),
Commercial cQ Other cQ __________ _
Work Type: Interior ~ Exterior 0 Both 0
Valuation of
Work Included Plans Included Work
Contact E-Mail: Ju;ki.-.:-~6 oe~tiJ.-'}:'Vil1oi.1, VDW\
I hereby acknowledge that I have read this application, filled out in full the M~chanical Qves 0No Oves 0No ¥.Dq:)
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 0Yes QNo QYes QNo of t:JflO
mation and plot plan, to comply with all Town ordinances and state laws, · ,. 51 fJJv-.
and to build this structure according to the town's zoning and subdivision Qves QNo "''es QNo $12 t::>1r:JVIJ
codes, design review approved, International Building and Residential Building ~T ~ ~
Codes and other ord.i!Jiinces of the Town applicable thereto. .Ji · .£~ ~~ ~ _ Total Value of all work being performed: $/jf~ .,, X ~~ ~ (value based on IBC Section 109.3 & IRC Section 108.3) /
Owner/Owner's Representative Signature (Required) Detailed Scope and Location of Work: f. g l j ;if 1,y~iJr
Applicant Information I-L ~ #_/_J I I ~ I1 .,,,,.!_
Applicant Name: ':1'4; obv·f"!V 1 '~,q;:~, l~>f'•ih' ';f'0 "i'h·:~11
---------------t'N.. -:K...,,., f P.1 11 .., ~\-rt#\}-e11r • 14'\f>\l'I fl'l'-t 11-\ \' J ~
Applicant Phone: ~
Applicant E-Mail: rt) Nx-~ ~ll "1'"A r$~rn brc.fJ •tcJ th #i~/,.Jy.
Additional Authorized ProjectDox Users "T'G~ry ·/:fl ,c. entry I
Full Name: ------------------
E-Mail: -------------------
Fu 11 Name: ------------------
E-Mail:. __________________ _
(use additional sheet if necessary)
For O~ce Use Only:..df.. ljC 7 b3
Fee Paid: J -, ~ •
Received From:--------------
Cash Check# ___ _
CC: Visa I MC Last 4 CC # exp date: __ _
Auth# ___ _
Rev. 2015-Dec
(use additional sheet if necessary)
Date Received:
MAR 2 ; 2016
TOWN OF VAIL