HomeMy WebLinkAboutB16-0485 Application.pdf Department of Community Development
75 South Frontage Road West
TOWN OF VAIL$ TVail,CO 81657
el: 970-479-2139
www.vailgov.com
BUILDING PERMIT APPLICATION
(Separate applications are required for Electrical,Alarm,Sprinkler&Public Way)
Project Street Address: - Project#:
4;O $- Zermaff Looe._ J)
(Number) (Street) (Suite#) DRB#:
Building/Complex Name: knaI I (DM"]QUI)S Building Permit#: 1116-0485
Project Information: nn � Lot#: Block# Subdivision:
Owner Name: Su i'7J I �/GAG�'l 'f�l-e—
arcel 0 / // / ^
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(0) Addition(Q) Alteration 0)
www.ea g l eco u n ty.u s/pati e)
Contractor Information Type of Building:
// t n I' Single-Family(0) Duplex(Q) Multi-Family(Q)
L•
Business Name: 0 re- S i�SL' 'il�i'y't 1�i n Commercial co) Other(0) 'TOG--.A\�o rg
Business Address: PO 3O 37p'�63 - -
City L9/e_ / State: CO Zip: gib Work Type: Interior '7 Exterior(Q, Both Q)
Contact Name: Gore c)f)See
Contact Phone: q 70 37C sc./9' Valuation of
p Work Included Plans Included Work
Contact E-Mail: a\05 (" . cod—)I hereby acknowledge that I have reithis application,filled out in full the Mechanical 0)Yes 1.4 No ()Yes M No
information required,completed an accurate plot plan,and state that all
the information as required is correct. I agree to comply with the infor- Plumbing Q)Yes Q)N° (QYes ONo /,3 9d
mation and plot plan,to comply with all Town ordinances and state laws, _
and to build this structure according to the town's zoning and subdivision 9
Buildin 0)Yes 0)No (QYes ON( �S
codes,design review approved,International Building and Residential
Codes and other ordinances of the Town applicable thereto.
otal
lue
f all work
eing performed:
X 726 e ,value based o ni C! Section 1109 3 8,IRC Section 108.3)$ .
Ownel7Owner's Representative Signature(Required)
Detailed Scope and Location of Work: ie-e fj6Ce_
Applicant Information %24 i� .• c_ &)Sk'`AJ
Applicant Name: �L(5Q/1 l✓7 �l
Applicant Phone: 97O /S �
S ���D he7f;r�ezi �`� f%le i b4 /OOM't c/fir)/ce p�l�c�
Applicant E-Mail: US IA-)y le S;/1lk VGA)171-y i ;14, (-lob Ile
� frn�
Additional Authorized ProjectDox Users � k �
Full Name: Athc/! !v cam—
E-Mail: C1priCe Vet/( .01L . COQ'?
Full Name:
(use additional sheet if necessary)
E-Mail:
(use additional sheet if necessary)
Date Received:
For Office Use Only:
Fee Paid: 3 0)
Received From: RECEIVED
Cash Check#
CC: Visa/MC Last 4 CC# exp date: NOV 1 7 2016
Auth#
Rev.2015-Dec Town of Vail