HomeMy WebLinkAboutB16-0176 Transmittal Department of Community Development
41) 75 South Frontage Road West
TOWN OF VAIL 57
Tel: 970-479 2Vail, CO 139
6--ewww.vailgov.com
BUIL PERMIT APPLICATION
(Separate a ' ations are quired for Electrical,Alarm, Sprinkler&Public Way)
Project Street Address: Project#:
5g_ 6 t_00/Vt. oc / �f
(Number) (Street) (Suite#) DRB#: P�j�16 ' COyhi -p
Building/Complex Name: Building Permit#: ( 1 L1`6 3(( )\\1 --S/6 O J72_
i Project Information: Lot#: Block# Subdivision:
Owner Name: 0-414/F"4 A/5Z/1/
Parcel# 7-/? //I 1 C / C'
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New( ) Addition ( ) Alteration (k)
www.eaglecounty.us/patie)
Contractor Information Type of Building:
Single-Family OO Duplex( ) Multi-Family( )
Business Name: 43-//4/ 6 ?('tJL G'Lf/tit Commercial ( ) Other( )
Business Address: hx / 7
City i')// ft/RA/ State: (0 Zip: e/1^(i.c Work Type: Interior( ) Exterior(X) Both ( )
Contact Name: --)C 1f)l/ Ckt 114741
Contact Phone: f 7D - '/7/-11S-7'3 7 Valuation of
Work Included Plans Included Work
Contact E-Mail: 161/Aj 4 5' 6 74,1,1CQAh/QGC/10k',NE'/
I hereby acknowledge that I have read this application,filled out in full the Mechanical ( )Yes ()C)No ( )Yes (/)No
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 ( )Yes (X)No ( )Yes (7)No
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 Building (�)Yes ( )No (x)Yes ( )No ii G
Codes and other ordinances of th a e thereto.
Total Value of all work being performed: $ //r nt7 0
(value based on IBC Section 109.3&IRC Section 108.3)
Ow Owner's Representative Signature(Required) 1 Detailed Scope and Location of Work:
Applicant Information
4, /7t41 (79l47''142
Applicant Name: —j/Ix ( 4-6(/47-e>/2
Applicant Phone: Q.7(i _.// 7/ 1-/ 'J-7 , ()%,P,77�
Applicant E-Mail: 761J7V e/1e,,t)V6 ' (64i 7,('GGEM/ Ili)L1 D /� A /1- `f-(i / � CD 4' .
Additional Authorized ProjectDox Users
Full Name:
E-Mail:
Full Name: (use additional sheet if necessary)
E-Mail:
(use additional sheet if necessary)
Date Recei 2
For Office Use Only: L�
Fee Paid: e
Received From: MAY 2 0 2016
Y.)
Cash Check#
CC: Visa/MC Last 4 CC# exp date: TOWN OF VAIL
Auth #
Rev.2015-Dec