HomeMy WebLinkAboutB16-0482.pdfTOWNOF~1~ 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)
Proj~ct Street Addres~~ 11 '\ _ . 4' ~ 63-fYlBY'\'1.LW Project#:-----------------
(Number) (Street) (Suite#)
Building/Complex Name: V. \ It 6J 4-J".il\ Y I; ~A-.. ORB#:----------...,.---------~
Building Permit#: ''r)( G-01:t:{; d-•
Project Information: , 0 A. 'I> . . Lot#:
Owner Name: ~ i'\'1l-Di LL< fh'Z,1, I ~S4Qo LL.C Block# __ Subdivision:--------
Parcel# ;){DI Of(, ;L 9f O,;J.o
(For Parcel#, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Contractor Information
Business Name: E tt(L S (!rv ·<... '-~
Business Address: :\>o Bo)( S 'lij
City \J '4-JL state: Co Zip: E91 ~:)6
Contact Name' G r ~;) £-1:> ~ ~
Contact Phone: 910 --41 \ -Lt °I '.)
Contact E-Mail: lLKo.k YJ o l~ch..:r;o. (of"'"\
I hereby acknowledge that I have read this applicatton, 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
Codes and other ordinances of the Town applicable thereto.
Work Class: New((') Addition (0) Alteration (0)
Type of Building: _/
Single-Family (0) Duplex (0) Multi-Family(~)
Commercial (0) Other (0). _________ _
Work Type: lnterior~erior (l) Both((')
Valuation of
Work Included Plans Included Work
Mechanical ('.)Yes (~ (C)Yes (~
r)Yes ((')No ((')Yes (0)No 4000. (l"..)
. Plumbing
Building {'.1)Yes (C)No (l)Yes (C)No2(3Ccb. 0
'
~ "''0 Total Value of all work being performed: U.ta., v v
{value based on IBC Section 109.3 & IRC Section 108.3) '
resentative Signature (Required) Detailed Scope and Location of Work: '3 -bc.4~f 00!V/ \
Applicant lnformati~ _ \ \ 1 G 'i ~ UL. :j=v1~I:? ~ W i j ~ W c \ \L \" ~ ~ owa~.
ApplicantName: r(.5 tJ>1 121 Ce1..1l10 Jro!V\ Q)cl).J,1') .n. 0 ft.
Applicant Phone: 411 -:,j.\,\Cj ')
( ~ I lv'\. \, ~J. OCC..1-tOV\ --i f\\.)IY°\bci_(OJ:_{.() Applicant E-Mail: e Ka.1~ 3 Q \J:-C~J ~~"(£). ( O,ll:\
Additional Authorized Projectbox Users 0 ~ ~~ ,<; dVV\ L. N cA Cro S \..1\J I tu,J \ ',bd) +
Full Name: ----------------~VI IV'\ c ±: -f·~ Vic i,S (__ ~ 9v\. ~ \) 0 \/011+
E-Mail: .:fi-v\W 11~ J1a.cdcfvlft:CJ= \ex . I~~ t I~ S' h &vJC:J('
Full Name: T ------------------(use additional sheet if necessary)
E-Mail: __________________ _
For Office Use Only:
Fee Paid: ____ ____.,. __________ ,,,___
Received From: ___ ......:::....._,,---------::;;...c:...--
Cash ___ _
CC: Visa I MC Last 4 CC # ___ _ exp date: __ _
Auth# ___ _
Rev. 2015-Dec
Date Received:
RECEIVED
NOV 14 2016
Town of Vail