HomeMy WebLinkAboutB17-0004.pdfDepartment of Community Development
75 South Frontage Road West
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:
ft5 t. tV\e~Lv bv \\JC 201
(Number) (Street) (Suite#)
Building/Complex Name: \J l \ \~t, Inn Pltt2.t?--
Project lnformcµion·\
Owner Name: '--J\ \jt\_ l.fur01(JYlR
Parcel # L / 0 I -(fl;; 2 -5'-f-(j} 8
(For Parcel#, contact Eagle County Assessors Office at (970)328-8640 or visit
www.eaglecounty.us/patie)
Contractor Information
Business Name: \-\t1J &mod.b\""0 4 Coll'i°:>-h-uuheh.. \l'\L.
Business Address: __.P_o~B~iS)(.~~W~O~<i~---------
City tv\\n-h.u'iA State: Co Zip: if<R±:L
Contact Name: f-J«~A .UC:1-A
Contact Phone: 0,10) 3°/0-Zlt;13
Contact E-Mail: °f'(0¥ .J..@ \)e..i t\ rt. tYlVde \(n3. Cc.m
I hereby acknowledge that I have read this application, filled out in full the
information required, completed an accurate plot plan, and state that all
the information as required is correct. I agree to comply with the infor-
mation and plot plan, to comply with all Town ordinances and state laws,
and to build this structure according to the town's zoning and subdivision
codes, design review approved, International Building and Residential
~' • t Tewo ''.pBrable thernte.
Owner/Owner's Representative Signature (Required)
Applicant Information
Applicant Name: f'uen.vrvi .\...\-(1?\
Applicant Phone: (q10) ?4o-2(LJ3
Applicant E-Mail: €,YrtwA (ii) he-1o!.rt-tY1ok l1n:).C.O\y")
Additional Authorized ProjectDox Users
Full Name: ------------------
E-Mail: ___________________ _
Full Name: ------------------
E-Mail: ___________________ _
(use additional sheet if necessary)
For Office Use Only:~: ,r--0
FeePaid: ~""::) -
Received From: ______________ _
Cash Check# ____ _
CC: Visa I MC Last 4 CC # ___ _ exp date: __ _
Auth# ___ _
Rev. 2015-Dec
Project#: _________________ _
ORB#: ______________ ,--__ _
Building Permit#: ---~-__..~l_:J __ --Q_Q_O_lf_· __ _
Lot#: Block# __ Subdivision:--------
Work Class: New ( Addition ( Alteration ( ---)
Type of Building:
Single-Family ( Duplex ( ) Multi-Family ( ~
Commercial ( ) Other (
Work Type: Interior (v) Exterior ( ) Both (
Valuation of
Work Included Plans Included Work
Mechanical )Yes )No )Yes )No
Plumbing )Yes )No )Yes )No
Building (J-1Yes )No )Yes )No
Total Value of all work being performed: $ /, 5r:x;Y I
(value based on IBC Section 109.3 & IRC Section 108.3)
' Detailed Scope and Location of Work: _______ _
-~eHJ 6\1 e, vtYlj \N vt l I , G ~h re,, I fuv -h h:.-
Sf nb t \&rs ' ~~ N Ai q \)f'\t-t-vh\ Ofj l k>Lfvre_.,
01.,hc\ ~hJ C£1l1n-01s st
¥-0htil-h I'{, ( i l'\'Jw mvtsler!xd-roo rn 6Y4j j;;--
(use additional sheet if necessary)
Date Received:
RECEIVED
.!AN 04 Z017
Town of Vail