HomeMy WebLinkAboutB17-0033.pdf Department of Community Development
i 75 South Frontage Road West
TOWN OF VAIL i ' 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 A dress; / Project#:
224 / h( R7
(Number) (Street) (Suite#) DRB#:
Building/Complex Name: Building Permit#:
1 -i -00.33
Project Information: Lot#: Block# Subdivision:
I"�� �1� .(2•05-i
Owner Name:
Parcel# Z/D -OF I Ste-O)
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(Co) Addition (0) Alteration (Q)
www.eaglecounty.us/patie)
Type of Building:
Contractor Information
�� :G� �C�L Single-Family(*) Duplex(()) Multi-Family(0)
Business Name: Commercial(()) Other(())
Business Address: PO scy 3 1-I
City 044(vim ZJ State: Co Zip: �I I�{1� Work Type: Interior(G) Exterior( Both(0)
Contact Name: LA-12s,(
Contact Phone: CnC) - 3,59- 33 42_ Valuation of
Contact E-Mail: Ou i Work Included Plans Included Work
'. 7J(2C f Dvethoo.C,
I hereby acknowledge that I have read this application,filled out in full the Mechanical e<ees (C)No (E Yes (eIo A
Bco
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 ((DYes (t,�j No
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
codes,design review approved,International Building and Residential Building (())Yes (0)No (0)Yes (�l No
Codes and other. •'.ances of the Town applicable thereto.
Total Value of all work being performed: $ 4
(value based on IBC Section 109.3&IRC Section 108.3)
0 Wr/Owner's Representative Signature(Required)
Detailed Scope and Location of Work:
Applicant Information
1=�2 - 7 12.1 '—ri24-,Ci
�1 fr�4A-C` 1�1C1�r 0115 L(•�
Applicant Name: —6- .fit.-i--0
Applicant Phone: e1,10 - O-92s....7 � ����' �� 7i7 A
Applicant E-Mail: ACCt-bOrc((14t . . .�1-e_c
Additional Authorized ProjectDox Users
Full Name: .,£iz--? 3o,2 L
E-Mail: C(.- hclGI 61 •csA4.4.1.Co'"I
Full Name: (use additional sheet if necessary)
E-Mail:
(use additional sheet if necessary)
Date Received:
For Office Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# exp date:
Auth #
Rev.2015-Dec