HomeMy WebLinkAboutB16-0128 special inspection transmittal.pdfTOWNOF9
Department of Community Development
75 South Frontage Road
Vail, CO 81657
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSMITTAL FORM
Use this form when submitting additional information for planning applications or building permits.
This form is also used for requesting a revision to building permits. A two hour minimum building review
fee of $11 O will be charged upon reissuance of the permit.
Application/Permit #(s) information applies
to: Attention: 0 Revisions J31 b -0 'd-<l .
Project Street A~A~es~: II 'jqtf<( !Y~u.)
(Number) (Street) (Suite#)
Building/Complex Name:--------------
Applicant Information
(architect, contrac~/,i °rwner/ow;er's rep)
"/_,Contact Name: ft/{ WiP~h-fY
Address: fivx / ..:Z 92'
City ££y£u/tt State: t'1c.-Zip: '6' 16::; /1 Contact~: -Ttoo~-------bc--:!~7-':i,.........----
I hereby ackno edge 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 information 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 ap-
proved, International Building and R ential Codes and other
ordinances o-· eto. ,) x /
,/'--'Owner/Owner's Representative Signature (Required)
For Office Use Only:
Fee Paid:-------------------
Received From: -----------------
Cash---------Check# _______ _
CC: Visa / MC Last 4 CC # exp. date: ____ _
Authorization#-----------------
O Response to Correction Letter
Ilattached copy of correction letter 0 Deferred Submittal O Other __________ _
Description of Transmittal/ List of Changes, Items Attached:
~s~~
(use additional sheet if necessary)
Building: $
Plumbing: $
Electrical: $
Mechanical: $
·Total: $0
Date Received:
AUG O 5 2016
TOWN OF VAIL