HomeMy WebLinkAboutB16-0383 Application.pdf i
Department of Community Development
75 South Frontage Road West
TOWN OF VAPt Vail, CO 81657
Tel: 970-479-2139
www.vailgov.com
BUILDING PERMIT APPLICATION
(Separate applications are required for Electrical,Alarm, Sprinkler& Public Way)
Project^ Street Addr ss:
r. S 0 LA Diktb t �.r�rJ 0) 1,0-•
I� Project#: C(�
(Number) (Street) �J�� (Suite#) DRB#: r j( jt L • O 1
Building/Complex Name: ini\1RtJ6 IBJ('s T. Building Permit#: 61(.o ' 0383
Project Information:8 a 1 I�1 Lot#: Block# Subdivision:
Owner Name: 11 I^ I(j/,I��} 1 00104.
i pi '
Parcel# oC,l v 6D`F' ° 1i\ vv °
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New( ) Addition ( ) Alteration)
www.eaglecounty.us/patie)
Contractor Information ;Type of Building:
j Single-Family( ) Duplex(
) Multi-Family V(1)
Business Name: � rv-�pe b 0lJ e , Oaf.,
,Commercial ( ) Other( )
Business Address:?' ' NY ii-lot
City 1W State: W Zip: 31 / Work Type: Interior( ) Exterior( ) Both( )
Contact Name: N,WO ' //ppF ���. • 1
1-
Contact Phone: 9 9-4-1 V wt5 i Valuation fi"'—
Contact E-Mail: 5.tt,41
D ��nnQ
XTi �� LUWork Included Plans Included Work /;
I hereby acknowledge that I have read this application,filled out in full the 1 Mechanical JYes ( )No ( )Yes ( )No ,. 7."-` "
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 ( )Yes ( )No ( )Yes ( )No
mation and plot plan,to comply with all Town ordinances and state laws, I '• . �}
codes,desl n -., a accodingre A. to the town's zoging and subdivision I Building <Yes )No )Yes )No �W r
he Town applicable International lthereto.and esidential a �.,�u�.._,__ _� �rvx ( Y-.a . — r
andto build this structure
9 pp
Codes and To dierl•'-, y
I'�Ij�I //n� i Total Value of all work being performed: $ ':•:','-.2.-=---'=--',.--:-7--
;
' _-- `-
�� II' ,/ i(value based on IBC Section 109.3&IRC Section 108.3) 1
,Owner/Ow -r's Re. ;•entative Signature(Required) Detailed Scope and Lo ation of ork: E
Applicant Information ` r t
op H.
± \LE�u --t t w K6pl X5riIV
Applicant Name: M • e� ,E� c ,
Q 11 if p� V
,Applicant Phone: ¶ - LRI- OS 85 "'� �$( p l `� 1,(�� /�1
Applicant E-Mail: Px V� b I U� g 1 purl I-C�c.�lvl ,
Additional Authorized ProjectDox Users
i
Full Name: (P Ii.I) /Ald, J 'I _g / 05
i
E-Mail: '
Full Name:
(use additional sheet if necessary)
E-Mail:
D E, it V
. ....- -....
(use additional sheet if necessary)
Date Received:
For Office Use Only: J
Fee Paid:
Received From: TOWN OF q/AIL
Cash Check#
CC: Visa/MC Last 4 CC# exp date:
Auth #
Rev.2015-Dec