HomeMy WebLinkAboutB18-0409.001 transmittal.pdf rr Department of Community Development
75 South Frontage Road
TOWN OF VAit Vail, CO 81657
Tel: 970.479.2139
www.vailgov.com
TRANSMITTAL FORM
Use this form when submitting additional information, changes&inspection reports for building permits.
This form is also used for requesting a revision to building permits. A two hour minimum building review
fee of$110 will be charged upon reissuance of the permit.
Submit this form only to: cdev_submittalkvailgov.com. Deliver paper plans to Community Develop-
ment or upload your revised/corrected plans to the appropriate project in ProjectDox,when requested.
Application/Permit#(s)information applies to: $1'8'—0 4 0
Revisions ( )Response to Correction Letter attached copy of correction letter
( ) Deferred Submittal r}-Other
Project Street Address:
1+6(9— Sica..rs•ide. c,r Description of Transmittal/List of Changes, items Attached,
Indicate changed plan pages:
(Number) (Street) (Suite#)
Building/Complex Name: Pilek Co uc ; t (e) el ee riG 1,
4 '-o
ho-t w-tier" 40A�g+v1 GI (LeLre-4.0",,,1 r)-
Applicant Information �{I )
V11�q G✓► ✓?$[,jt,'vr �t7Pf@sem
(architect, ontractor .wner/owner's rep) `� f �° { f P.
e Y f--.i dAn-sy/i fc6441 ./ i/�Ge far L,�f6 %
Contact Name: ��Sa� 141a,,,te XIII.'iti9 CJu;4 I,1d 6641 Ty/l tA%f
Address: Pel n X 301 (2 ee4,1 C. tf' L414 w4s•t'er) 4e� ice, .
Zip: �a (use additional sheet if necessary)
City Ci1)Lewap or State: c //////
Gds,vet-11%4j 44 ®ht c 3-yr(e . •
Contact Name: 5r5'i,..,e
Building Permits:
Contact Phone: 7,2O. 6-7 , GG!/ Revised ADDITIONAL Valuations(Labor&Materials)
rr (DO NOT include original valuation)
Contact E-Mail: rd,,. -a rfkw�S�.se c� �.CGu..-
Building: $
I hereby acknowledge that I have read this application,filled out
in full the information required,completed an accurate plot plan, Plumbing: $ G U()
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 Electrical: $
ordinances and state laws, a r.,to build this structure according
to the town's zoni • and subi,iv.ion codes, design review ap- Mechanical: $
proved, Internation- ildi i an Residential Codes and other /
ordinances of the. .vvw j licab- thereto. Total: $ .2.)6. 6
X
Owner/Owr �;=presentative,\Sig ature(Required)
Date Received:
21.-Apr-2017