HomeMy WebLinkAboutB17-0086.pdf -
Department of Community Development
--� 75 South Frontage Road West
TOWN OF VAIL` 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 Address: Project#:
11J,ts t V\. Z
(Number) (Street) (Suite#) DRB#:
Building/Complex Name: Building Permit#: J l' ` C O is
Project Information: Lot#: Block# Subdivision:
Owner Name: elf-(14 04-Cls \ t \ 2
Parcel 11. SGL— t'tt—(y' Dt1
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(C') Addition(n) Alteration((
vremeaglecounty.us/patie)
Contractor Information Type of Building:
Single-Family r) Duplex((VI. Multi-Family(n)
Business Name:_14 I.-3-NL- ' h 'F%1C , 'i+A-C't 5v ('
r �(� '!� Commercial(�) Other( .)
Business Address: c4A0 v&.O}>, _wt 5a
City 'Au 0 A- State: Cu Zip:- =ti.(, Lt Work Type: Interior(Exterior(C) Both(r)
Contact Name: N L K Lei e.1m✓s ✓`
Contact Phone: q7U t'1-' Ls 2'3 Valuation of
Work Included Plans Included Work
Contact E-Mail: IN tku.) e WC-Act/V%- tYt IsStcp.,CoLG 4.4.4 r, 1�
I hereby acknowledge that I have read this application,filled out in full the Mechanical Yes (C)No (( es ( )No 8'1� I—1
information required,completed an accurate plot plan,and state that all Q
the information as required is correct. I agree to comply with the infor- Plumbing ((V)Yes (C)No ((rYes (r
)N0 1*
mation and plot plan,to comply with all Town ordinances and state laws,
and to build this struct - according to the town's zoning and subdivision �^
codes,design w...pr. ed,International Building and Residential Building ()Yes (l,. )No (r)Yes (r)No
Codes an er or. . -s of the Town applicable thereto.
Total Value of all work being performed: $ ',!I V
X (value based on IBC Section 109.3&IRC Section 108.3)
Owner/Owner's -epresentati ignature(Required) Detailed Scope and Location of Work:
Applicant Information
Zr lu c .v c' "u'Ce ltxct
Applicant Name:
Applicant Phone:
liv).estvH &1/4. •fet dk Vrti�r- t
Applicant E-Mail: f "f G -1 u t
Additional Authorized ProjectDox Users F vrc \u C_ X\NI C.v�Ont., " L - - 'i-
Full Name: F U G1_
E-Mail:
Full Name: (use additional sheet if necessary)
E-Mail:
(use additional sheet if necessary)
to Received:
For Office Use Only: 5 RECEIVED
Fee Paid: i�S� 3 '7
APR 04 2017
Received From: _
Cash Check#,;4. 3 i I c'
CC: Visa/ MC Last 4 CC # exp date: Town of Vail
Auth #
Rev.2015-Dec