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HomeMy WebLinkAboutB16-0197.pdfTOWN OF~ Department 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 Stree:?h:ss: ._ f) 1 / : I ?59 enc&v f2,d.1 'f\/:f l_-. ' (Number) (Street) (Suite#) ' Building/Complex Name: ,lffas JA_,t1T J;q,i/t/ ,,10/J1€'S : Project Information: 'tiI. 1} ' l Owner Name: ~11/c(y Gc.)e~tl' {ere:> Parcel# bf /5 f{. Sub 61-1/kJ<Ji ~ ' (For Parcel#, contact Eagle County Assessors 0 e at (970)328-8640 or visit www.eaglecounty.us/patie) " ~ ·,y==- Project#:---------~-------- ORB#: -Y~0~ Q ll l Building Permit#: JS/ ki -[) / CJ f _ Lot#: Block# __ Subdivision: _______ _ Work Class: New ( Alteration <X) Addition ( Contractor Information '1-/ t' -~ f d-3 :;2.__ 3 CJD 0 -3 i Business Name: _-----_1-={!;~])~------------- Type of Building: Single-Family ( X) Duplex ( ) Multi-Family ( Commercial ( ) Other ( ) __________ _ • Business Address: ________________ _ ·City __________ State: ___ Zip: _____ · Work Type: Interior ( ) Exterior ()() Both ( i Contact Name: ------------------ Contact Phone:------------------ ' ! Contact E-Mail:------------------, 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 infor- 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 codes, design review approved, International Building and Residential j Codes and other ordinances of the Town applicable thereto. :x~-2 <3 • Owner/Owner's Representative Signature (Required) ! Applicant Information • i Applicant Name: /(}iNe-JybU::?f1-/eY'O I 'Applicant Phone: 'J?e? 370 /5'/o/' . Applicant E-Mail: K~ V"1 > L ~ f/o /_ r ~ · Additional Authorized ProjectDox Users Full Name: ------------------· , E-Mail: ____________________ _ Valuation of Work Included Plans Included Work Mechanical )Yes (.\;')No )Yes )No Plumbing )Yes (,X)No )Yes )No Building c.k2_Yes ( X)No )Yes llJ_se d:', )No _ Oc Total Value of all work being performed: $ _____ _ (value based on IBC Section 109.3 & IRC Section 108.3) Detailed Scope and Location of Work: ----~----.- :Pvsf&/ ( & I~""!, <>n ,:::K>d h 3 1b dG7 flov<.4/ ~ K. ~ 11/ ~ pa?v--fv Lr l!rl".J? Bre.c:; 1 &fc·c-'v1 u;1/(if' Ct bove C-ct r /Jcrf- · Full Name: -------------------'(use additional sheet if necessary) : E-Mail: ____________________ _ ' (use additional sheet if necessary) For Office Use Only: Fee Paid: 6''-f 30 Received From: ______________ _ Cash ____ Check# ____ _ CC: Visa / MC Last 4 CC # ___ _ exp date: ___ _ Auth# ___ _ Rev. 2015-Dec Date Received: 0 ~©~~\\/;71§'.lnl MAY 3 l 2016 . ~ TOWN 9F: VAIL ___ j