HomeMy WebLinkAboutB16-0490.001 transmittal.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
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-6\u- 0�(A O ��'7N1 0 Response to Correction Letter
` I-1 attached copy of correction letter
Q Deferred Submittal
O Other
Project Street Address:
-3d3 C cN.e._ e -eQk- aL- )7--
(Number) (Street) f (Suite#)
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Building/Complex Name: Y G1,1 ROLA)ke161_)�,S Description of Transmittal/List of Changes, Items Attached:
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Applicant Information �1-
(architect,contractor,owner/owner's rep) 5A -\-vY €_- 1
Contact Name: �'(� `\d`�� � C_- 0_0(\``( tA(CCx1 r�7� \
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Address:
City State: Zip:
Contact Name: Sexy-C,0"---- additional sheet if necessary)
Contact Phone: 1t 01 O 11 L'' Building Permits:
(�S?£�1`66 .���� Revised ADDITIONAL Valuations(Labor&Materials)
Contact E-Mail: `% (DO NOT include original valuation)
I hereby acknowledge that I have read this application,filled out Building: $ t) . I
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-
• • d International Building and Residential Codes and other Mechanical: $
ordinances of the Town applicable thereto.
Al Total: $0
Owner 0,/gs Representative Signature(Required)
Date Received:
For Office Use Only:
Fee Paid:
Received From:
Cash Check#
CC: Visa/MC Last 4 CC# __exp.date:
Authorization#