HomeMy WebLinkAboutB17-0012.pdf 74,/c_....- Department of Community Development
75 South Frontage Road West
Vail,CO 81657
TOWN OF VA I L Tel: 970-479-2139
www.vailgov.com
BUILDING PERMIT APPLICATION
(Separate applications are required for Electrical,Alarm, Sprinkler&Public Way)
Project Street Address:
Project#:
iq c./ 0.,/reit, 0/—
(Number)
ir(Number) (Street) (Suite#) DRB#:
Building/Complex Name:Bt f91Chsta I Duplex Building Permit#: k 1-1—"G C
Project Inform tion: Lot#: Block# Subdivision:
Owner Name: 0 I'-a471 C�int r (i:unci
Parcel#a!03-03-- C 02,c
(For Parcel#,contact Eagle County Assessors Office at(970)328-8640 or visit Work Class: New(C. Addition(C) Alteration(X)
vAvw.eaglecounty.us/patie)
Contractor Information Type of Building:
Single-Family(C) Duplex O Multi-Family( ')
Business Name: CSh &✓eplC ZZ, , (� ,f) 1 l.
Commercial(r) Other(C)
Business Address: g10 fV I-h iigl-)11 n- ftf_s.LI
City 'L)�'l State: CO Zip: 6I/1(2)0 Work Type: Interior( ) Exterior(C) Both(C)
Contact Name: /0ICti<JC-S Lk_)C1khh
Contact Phone: 0171' fl-"L-1-91(-1 I Valuation of
Work Included Plans Included Work
Contact E-Mail:kl is K.r t ,CCi>i kr 4f4,41-6 rebQrcx Ce,el n-t
I hereby acknowledge that I have read this application,filled out in full the Mechanical OYes (C)No (C)Yes (C)No
information required,completed an accurate plot plan,and state that all /-� n ' / �(�
the information as required is correct. I agree to comply with the infor- Plumbing ((^;)Yes (g)No (C)Yes (C)No I V/ 'TQC
mation and plot plan,to comply with all Town ordinances and state laws,
and to builis stru according to the town's zoning and subdivision
codes,d ign vi app ved, nternational Building a esidential Building i.)Yes (C)No (t )Yes (\)No
Codes d othe o dinance o e Town applicabl ereto.
Total Value of all work being performed: $ I3(Y)
X (value based on IBC Section 109.3&IRC Section 108.3)
Owner/Owner's Represe i e Signature(Required) Detailed Scope and Location of Work:
Applicant Information
Q L fo iat v1 6 vT U Ol reC:f"
Applicant Name: li (i
os Phone: U01ll.i r,0 (Thi f- _ ' "��S c-7 j f i t-L
Applicant E-Mail: /At/Oil O 5 vrxl I( lZa c.1 t o vi \— `7 f it j
App t
Additional Authorized ProjectDox Users
Full Name:
E-Mail:
Full Name: (use additional sheet if necessary)
E-Mail:
(use additional sheet if necessary)
Date Received: RECEIVED
For Office Use Only: L FO - C4,
l5!Fee Paid: G+}�; _ - JAN 17 2017
Received From:
Cash Check# Town of Vail
CC: Visa/MC Last 4 CC# exp date:
Auth #
Rev.2015-Dec