HomeMy WebLinkAboutB16-0308.pdf(Separate apP. ·
Deparbnent of Community Development
75 South Frontage Road West
Vail, CO 81657
Tel: 970-479-2139
www.vailgov.com
Project Street Address:
OQ? I 351 G C.Q~ n h.d\ . J .. Project#: _____________ _
tti~J Sltu'
(Number) (Street) (Suite#) DRB #: -----~~~----------
Building Permit#: "'Bl 0'; 0 3Cft ' Building/Complex Name:-------------
Lot#l'lff Block#f_ Subdivision: 6 ~b LytJ I\ Project lnfonnation: . ·
Owner Name: 1( I Jiad +-J 1J.Y.. · tv\ £.; -s.+LJ&~
Parcel# ,) I() "t> -l~.t.1-0 ~ -0 {9
(For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Work Class: New( Addition ( Alteration~
Contractor lnfonnation Type of Building:
Business Name vJ&f;. I !k=f ~
Business Address: :J:.a ~ 19B
e 4rt c/i Single-Family ( ) Duplex~ Multi-Family (
_h-S.: t.l~Nkommercial ( ) Other ( ). _________ _
City f?tAy:t State: le Zip: fl f.t 3 { Work Type:
Contact Name:~ a,£·,hi.11 fy()(,Jl (q; \l .iJJ/ ()<..{!,l
Interior ( ) Exterior f Both ( )
S? (,1J1rd~ws
Contact Phone: C/70 3 90 ]tr3 ,)....... I _/ ~ · ~k, fr ·, Worklnduded Contact E-Mail: (~.12~ e { t' )',Lyne 1 AS CJt1l$ 7!.<..+, ~ ·~ ~ Plans lnduded
Valuation of
Work
I hereby acknowledge that I have read this application, filled out in full the Mechanical ( )Yes )No JYes ( 'fao
<)4No
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
mation 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
)Yes ( )No ( )Yes
codes, design review approved, International Building and Residential Building
Codes and other ordinancet:/ the To.wn ap~licable thereto.
X lfltv·t~,v~/
( )Yes ( )No ('jves ( )No /IJ, ,;;;;;<{. J ~
Total Value of all work being performed: $ /tJ >.;:).&, 33
(value based on IBC Sedion 109.3 & IRC Section 108.3) 7
Owner/Owner's Representative Signature (Required) Detailed Scope and Location of Work: --------
Applicant lnfonnation t7 1 7-.. A 1 1 t" -l. c p,j},o-i ce. A •'-1, h-tUi' is
Applicant Name: 02 a]) ~) e l;;{/)U) t .Q_, I I ": Sa Y"-e r1-~ Sa t-vJ!--Applicant Phone: CJ '"{/) ~q 0 7:13 'J--/
Applicant E-Mail: d...('kb; e_ f £~·~ h4t,.,t,1A.S, (tbS.hu-+·......,. ________________ _
Additional Authorized ProjectDox Users
Full Name: ')), ,,,kbr.e G~w/.V
E-Mail: d..etbie C u/Ct../h-Rhtisk.1">..Sc ftf\.~fra.~. l~-----------------
Full Name: ------------------(use additional sheet if necessary)
E-Mail:. __________________ _
(use additional sheet if necessary)
For Office Use Only:
Fee Paid: _______________ _
Received From:--------------
Cash Check# ___ _
CC: Visa I MC Last 4 CC # ___ _
.Auth JJ ----
exp date: __ _
TOWN OF VAIL
Rev. 2015-Dec