HomeMy WebLinkAboutB16-0155 Application.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 Street 19dress~ fA -h. (
77lJ r ()ffffp 11 e-~ Dr.
(Number) (Street) f:J . Building/Complex Name: 7 7D ~f~Y/o
;?. (Suite #)
tltfci.
Project Information: M , v _1..
OwnerName: _!lfy E /1.!-.t fe;le.r.;>t~rt
Parcel# 92 /()I Ob!u croo.z
(For Parcel #, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patle)
Contractor Information :~::: :::~. r<pt tr,! ~"* :p c" 7A c
City F?:J [ e """" ~ Zip• 8. flz5 /
Contact Name: !?o0 ( r t11 :_I?. h e (/
Contact Phone• ~ -37 6-0 ~-e.
Contact E-Mail: f~ •tc 'e /( f(jafltf-/(.c c?ttl\,
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 eview approved, International Building and Residential
Codes and o er ordina s th own applicable thereto.
X. __ ~~~~~---------------ownerto er's Representative Signature (Required)
Applicant Information
Applicant Name: _,_,_ ........ ,...._...______;_-'--....,."'4-=-<-'------
Project#:-----------------
ORB#: _____________________________ _
Building Permit#: _ _.(S~~::::o~o+\l:o...J.Jl~~-o'_..,O ....... \tJ...._..S.__ ____ _
Lot#: Block# __ Subdivision:--------
Work Class: New((') Addition((') Alteration <r)
Type of Building:
Single-Family (C) Duplex{") Multi-Faml ((')
Commercial{"':) Other(~ ~u1aiJ f
Work Type: Interior <f/.> Exterior (C) Both (l)
Valuation of
Work Included Plans Included Work
Mechanical (',)Yes (q()No (CJYes {')No
Plumbing (')Yes ((/()No (C"')Yes (C"')No
Building {\)Yes (C)No (C')Yes {-:)No Z-.l 0 {)0 •
Total Value of all work being performed: $ 2, OCJD
· (value based on IBC Section 109.3 & IRC Section 1 08.3) 1
Det~il~d Sea e and Location -~fW~rk: -_--...:..('....!-~-.!..'-,..L-·=---L.:....~.:~::l.l-\
1/ L ((
Applicant Phone: """"-f.!'=-=:~::::....!...-.!..-....:::.1.....¥-U,.!..lr.-.fl:l.---1~+-.loo::::::.J...l.J~4--!.L...l.4-~
Applicant E-Mail: -...L.......J....!:!:U.....LJ....::fi.!=.L.L-.4~(:=~<j-UJ'4.1-'-::lo.o;J~ ----'~~~~ ...... ..!....!<::.......l=-.~..1.¥~'->:+--f-~-~~~...w,....
Additlonal Authorized ProjectDox Users
Full Name: ------------------
E-Mail:. ___________________ _
Full Name: ------------------(use additional sheet if necessary)
E-Mail:. ___________________ _
(use additional sheet if necessary)
Date Received:
For Office Use Only:
Fee Paid: '--~S-v\
Received From:--------------
cash Check# ___ _
CC: Visa 1 MC Last 4 CC # exp date: __ _
Auth# ___ _
Rev. 2015-Dec