HomeMy WebLinkAboutB16-0358.pdf 1110 Department of Community Development
75 South Frontage Road West
TOWN OF VAILVail,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: Project#:
iQOg SL71J �.S
(Number) (Street) (Suite#) DRB#: Q`
Building/Complex Name: Building Permit#: 1' Or
Project Information: Lot#: Block# Subdivision:
Owner Name: A?Q1Z.tJ
Parcel# 2-ICA —CA —03 -Ods
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(r') Addition(C--) Alteration((R)
www.eagl ecounty.uslpatie)
Type of Building:
Contractor Information
`` Single-Family(X) Duplex(C) Multi-Family(C
Business Name: 14
* ►� {i oMic,, SaIIWILL I NL- Commercial(C) Other({)
Business
� �j'Address: }� CAL QIq
LOO OO State: Zip: 10(Q2.0 Work Type: Interior(X) Exterior(C) Both(r)
Contact Name: ci ek
Contact Phone: 910' 33k '$QQZr Valuation of
. Work Included Plans Included Work
Contact E-Mail: ` �si•t a le.fr-3A01.01-61st
I hereby acknowledge that I have read this application,filled out in full the Mechanical X)Yes (C)No r Yes (C)No 2 e.606
information required,completed an accurate plot plan,and state that all
the information as required is correct. I agre- o comply with the infor- Plumbing C)Yes (C)No (C)Yes (C)No
mation and plot plan,to comply with all • ordinances and state laws,
and to build this structure actor.' .'--i a town's zoning and sub ivision
codes,design review appro •i!'� etional Ili din sidential Building (C)Yes (C)No (C)Yes (C)No
Codes and other ordina;-�. a Town e thereto. ?-�
Total Value of all work being performed: $ Z COO
X (value based on IBC Section 109.3&IRC Section 108.3)
Owner/Owner's Representative Signature(Required) Detailed Scope and Location of Work: eIM•
Applicant Information
� upG Vi- \ f.-Peri
�
Applicant Name: \ext01Ar1T \Liotfc- 'SLe
Applicant Phone: T-zo•- ( -gjoZ �,�� � `� - �G�_
Applicant E-Mail: 14444.rSL-�.t)1C•L AOL•�iM • `�`Cr1� 1s:.t'H Z k-�i2v1�1/U1G�N�
Additional 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: E (r +� i�
Fee Paid: 440 D _5 , `/ ��� �,
Received From: I
Cash Check# L)Ci f; 1 2016
CC: Visa/MC Last 4 CC# exp date: _
Rev.2015-Dec