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HomeMy WebLinkAboutB16-0253.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 Address: iLfJY Cbl11~ biwe ·Dr (Number) (Street) (Suite#) Building/Complex Name: s+€..€1 m S;DE-'T(M;tJ ~t)!)i;.l;f Project Information: Owner Name: . ke di. V R..e; Dy Parcel # "Z. I() I -I 2.. L --2.. f>DD -I (For Parcel#, contact Eagle County Assessors Office at (970)328-8640 or visit www.eaglecounty.us/patie) Contractor Information Business Name: Lm 5 Col'\ s ±cut. t ,·a\.../ Business Address: -Po f&i 1t 3'-i 'i.1 City \JC/\,, \ State: (o • Contact Name: l =££. S-eJo.\-<,, Contact Phone: 'l1D-3'i 3-1. I "'"3 Zip: Project#:.....,_ ________________ _ ORB#: DPBISQSod-. Building Permit#: ~I b-0 d:-.. 5 :3 Lot#: Block# __ Subdivision: _______ _ Work Class: New ( Addition ( Alteration~) Type of Building: Single-Family ( Duplex fif}) Multi-Family ( Commercial ( ) Other ( ) _________ _ Work Type: Interior ( Exterior r? Both ( ) Contact E-Mail:lnS Y>v• s·f:clfYh 0 1V 1~ ]£ Grf\Ct; I. (cl~ Work Included Plans Included Valuation of Work 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 Cod"~ mdloaooo' of tho To~ appll"bl' tho<eto. x ' 1 .Ji~ . Owner/Owne?'S Representative Signature (Required) Mechanical )Yes Plumbing )Yes Building )Yes )No )No )No )Yes )Yes )Yes )No )No )No\ '?Jow1 ,,.v Total Value of all work being performed: $ J~. 01) ! (value based on /BC Section 109.3 & /RC Section 108.3) ' i Detailed Scope and Location of Work: _______ _ . Rep\actZ E'(1~4-1 ") "'°'\ \ '"'") .s Applicant Name: -------------·uJ/ tJLtW i!\e.~ \ np,J vsi..tc S Per Applicant Phone:----------------- Applloant E·Mall \h..wlh) _j(gj11t\ 1;i:;' ~ 1 -&i15~ Applicant Information Additional Authorized Projectoox Users ~ f:>o~-0 S. W 1-.N_Ll.J) Full Name: ------------------ E-Mail: ___________________ _ Full Name: ------------------(use additional sheet if necessary) E-Mail: ___________________ _ (use additional sheet if necessary) For Office Use Only: . '1 '\ ( Fee Paid: IU /. Received From: __ \.-_\/V\..._ __ S _________ _ Cash Check# __ l_l_C\_\._ Date Received: ~©~DW~ n JUL o 1 2016 U ~ f ;o1J CC: Visa / MC Last 4 CC # ___ _ exp date: __ _ TOWN OF VAIL Auth# ___ _ Rev. 2015-Dec