HomeMy WebLinkAboutD16-0005 Application.pdf~
TOWN OF ~ML1J'
Department of Community Development
75 South Frontage Road West
Vail, CO 81657
Tel: 970-479-2139
www.vailgov .com
Project Street Address: {) • \} , Project#: }3t; \tJ f]n~e11= ·~ ~Ice }5-i0S?------------
{Number) {Street) {Suite#) ORB#:------------------
Building/Complex Name: Va-ll ~;II~ H li0\ ( iblod... I Building Permit#: __ :})_);...L-:\!......:\a=--·=O~u.J:...=-..l!.<S-::.___ ___ _
Project lnformation:fi' L'o .f : l I
Owner Name: J. o-k_ I'Vtti S Lot#: Block# __ Subdivision: _______ _
Parcel# ')..--
(For Parcel#, contact a le County Assessors Office at (970)328-8640 or visit i Work Class: New ( ) Addition ( ) Alteration ( ) j
www.eaglecounty.us/patie) 1-----------~~-------.:v:( __ :~----~-----------·-------J
C t t I f t. .\Type of Building: ' on rae or n orma ron 1 /. . c .All t7 , 0 ·I Single-Family ( ) Duplex ( V) Multi-Family (
Bus mess Name: ;}kAV'v'\ vv let-S W 1(.1(/S tv fW:hOVI "'--\ Commercial ( ) Other ( ) __________ _
Business Address: LOUJ I c; YY\ai Ill .rt CG&l """1 ~--------=--~-==~--====-
City m I (\fum , State: Co Zip: '616 '-6 1 Work Type: Interior c.;( Exterior ( ) Both ( ) '
Contact Name: ~ W\{A;t-U' C-~ !-==·~=~==,=~~~~~=-~~-=--~-~-~~=~~=-=====~-=J
Contact Phone: jl Valuation of I ~ Work Included Plans Included Work i,
Contact E-Mail:-----------------l • I
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
~OOe• ood oth .. '"'":~L,heceto
esentative Signature (Required)
l Mech~nical )Yes )No )Yes )No ~Iii
~ Plumbmg )Yes )No )Yes )No --. __ _
I Building ( )Yes ( )No ( )Yes )No $' ~00 I {§V !~,~~~:~~=-~:~~~~~ work being performed: -$ ~900 111~
(value based on IBC Section 109.3 & IRC Section 108.3)
r-----------------------------------------~' ! Detailed Scope and Location of Work: _______ _
Applicant Name: ~ Mt~"lclu,VV\ I ~ A-'"'1 +o 1 "'~""" C&~v'n ...
AppHcan!Phone: ' ""!tv 'lolf: ?-<eo5 I ""~~ -.,...,·tv:: v""'11
Applicant E-Mail: ~ (9 ~'V"'-VV\t\ ~ J.ov.-· Cc..w\ I ~ ~
Additional Authorized PA;;Jcmox Users '--~----'-'-=-~-=-=---.Lf?---=-lt,-'----"cg__,____._ _________ _
Full Name:-----------------~ ~
E-Mail: _____________ , Prt keo<Jo£ ~~
Full Name: I ------------------j (use additional sheet if necessary)
E-Mail: ___________________ I
! . . .............. --
1 (use additional sheet if necessary) i Date Received:
r-----------------------~1
For Office Use Only: riJtZ. ~J(\ tJ
Fee Paid: -----=~~""----ft--J--__:_[I_,=f-----'-·J~\olol----AUG 16 2016 Received From: ______________ _
Cash Check# ____ _
CC: Visa I MC Last 4 CC # ___ _ exp date: __ _ TOWN OF \(AI~
Auth# ___ _
Rev. 2015-Dec