HomeMy WebLinkAboutB14-0240_B14-0240 Transmittal - Inspections_1414438080.pdf Department of Community Development
75 South Frontage Road
TOWN OF VAIL ' Vail, CO 81657
Tel: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSMITTAL FORM
Use this form when submitting additional information for planning applications or 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.
Application/Permit#(s) information applies
to: Attention: 0 Revisions
B14-0240 Warren Cambell b Response to Correction Letter
n attached copy of correction letter
o�Deferred Submittal
R J Other Med Gas Cert.TB report Phase 2/3
Project Street Address:
181 W. Meadow Dr.
(Number) (Street) (Suite#)
Building/Complex Name: Vail Valley Medical Center Description of Transmittal/List of Changes, Items Attached:
Med Gas Certifications phase 2/3
Applicant Information
Test& Balance Report Phase 2/3
(architect, contractor, owner/owner's rep)
Contact Name: Haselden Construction
Address: 6950 S. Potomac St.
City Centennial State: CO Zip: 80112
Contact Name: Nick Rubino- Haselden Construction
(use additional sheet if necessary)
Contact Phone: 720-398-7831
Building Permits:
haselden.com Revised ADDITIONAL Valuations (Labor&Materials)
nickrubino
Contact E-Mail: @ (DO NOT include original valuation)
I hereby acknowledge that I have read this application,filled out Building: $
in full the information required,completed an accurate plot plan,
and state that all the information as required is correct. I agree to Plumbing: $
comply with the information and plot plan, to comply with all Town
ordinances and state laws, and to build this structure according Electrical: $
to the town's zoning and subdivision codes, design review ap-
proved, International Building and Residential Codes and other Mechanical: $
ordinances of the Town applicable thereto.
XNick Rubino 3 ;osoode�oomo-��a�ae�.o�_�a,a�de� Total: $0
Owner/Owner's Representative Signature(Required)
Date Received:
For Office Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp. date:
Authorization #