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.4,4r%�.A'f%) Department of Community Development •
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75 South Frontage Road West •
TOWN OF VAIL _jveil,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#:
1 F Ut. blAS ItrY 04. Gr a
(Number) (Street) i (Suite#) DRB#:
Building/Complex Name: .,1 0 A.Ck& F1(1 aAte Building Permit#: 1`1 ` G I 0 I
g 1 O 1 6b7, i 4 OO2Project Informtn:
Lot#: Block# Subdivision:
Owner N me: ► Q o FAN I
y i f
Parcel 50'C i 1 C / 131 d C LL l LTD
(For Parcel#,contact Eagle County Assessors Office at(970)328-8840 or visit Work Class: New(� ) Addition((--) Alteration(ZK)
www.eaglecounty.uslpatie)
Contractor Information Type of Building:
I.? * Single-Family(C) Duplex(C ) Multi-Family(c)
Business Name: .644 t,}' V AASt r(,), ,-ti { Commercial(C) Other(r)
Business Address: PO ?DUB ?S
City Q'J 1 State: Zip: 01:b d 0 Work Type: Interior(k) Exterior(C) Both(-)
Contact Name: lXX:\Pe bY2't:r 1AM
Contact Phone: CA,A\ -3 8'-a 3 O4,
Work Included Plans Included Valuation
of
Work
Contact E-Mail: (4 Oh -(t/ n"t `iO4i-
I hereby acknowledge that I have read this application,filled out in full the Mechanical l`^)Yes (C)No ()Yes (r)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 CX)Yes (C)No ( )Yes (l^
)No r.,, D D
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 ,--- v p
codes,design review approved,International Building and Residential Building C)Yes (C)No (r)Yes (k )NO `
Codes and other ordinances of the Town applicable thereto.
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Total Value of all work being performed: $o 4.�Z, c.
X t/ 1 i77- b)74, (value based on IBC Section 109.3&IRC Section 108.3)
Owner/Owwner39)presee Signature(Required) Detailed Scope and Location of Work:
Applicant Information�r` r m Wk,l bCkt 11 r 6 V r r l S
Applicant Name: IM�`�bb r k V LAA\11\ �°l W Lu ice,/
Applicant Phone: 1 U 7� l'a j '✓l�
Applicant E-Mail: /�' . As ►. ► An 'i -- ,o. b U\ C AA( Lill() UC
Additional Authorized ProjectDox lasers
Full Name:
E-Mail:
Full Name: (use additional sheet if necessary)
E-Mail:
(use additional sheet if necessary)
Date Received: RECEIVED
For Office Use Only:
Fee Paid: $ ;14 -7 , 36. APR 10 2017
Received From:
Cash Check# Town of Vail
CC: Visa/MC Last 4 CC# exp date:
Auth#
Rev.2015-Dec