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TOWN OF VAIL CONSTRUCTION
PERMIT APPLICATTON FORM
DATE:
PERMIT /I
bt rb
OUT COI.{PLETELY OR IT MAY NOT BE ACCEPIED
PERMIT INFORMATION * * **** * * * ** * ** ** ******* ** * ***
l-Electrical ffi-Uectranical [ ]-other
}.kAuu.""=l ' Lnat MttwtY.
Legal Description: Lot
Ol{tners Narne:
Architect:
Block_ Filing susprvrsroN:
Address: 5A.n^€Ph.
Address: .O'fr5+36
, APPLICATION MUST BE FILLED
if, ***** ** * * *********** ** * ******rl [ ]-Buitding I l-Plunbing t
ceneral Description:)
lUrmber and Tltpe of Fireplaces: Gas Appliancesv
,t* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * VALUATTONS
P,@
Number of Accomrnodation Units:
cas Logs_ Wood/Pellet
oFFrcE usE *******************************
BUTLDTNG PI,AN CHECK FEE:
PLI'MBING PI,AN CHECK FEE:
MECHANIcAL PLAN cnncx sBgs -7zF-
RECREATION FEE:
CLEAN.UP DEPOSIT:
*********************************
ELECTRTCAL: $OTHER: $
MEcHANrcALr lW.TOTAL: $
CoNTRACTOR INFORMATION * * * * * * * * * * * * * * * * * * * * * * * * * * *
Town of Vail Reg. NO.
Phone Number:
Town of vail Reg. NO.
Phone Number:
Town of Vail
Phone Number:
Town of VaiI
Phone Number:
Reg. NO.
I{ork class: [ ]-New 1r{-ota.r.tion [ ]-Additional
t,g\-nenair t l-other
Nurnber of Dwellinq Units, I
Address:
Electrical Contractor:
Address:
Address:
MechanicalAddress:
******************************** FOR
BUTLDTNG PERMIT FEE:
PLI'MBING PERMIT FEE:
I.{ECIIANTCAL PERMIT FEE. Z'--
ELECTRICAL FEE:
OTHER TYPE OF FEE:
DRB FEE:
-l
BUTLDTNG:
STGNATURE:
ZONING:
u]-t,rtrr,rUt\lL:r--t-_--l_--lConments:
ontractor:
VALUATION
CLEAN T'P DEPOSIT REN'ND
75 south lronlage road
Yail, colorado 81657
(303) 479-21_38 or 479-2L39
TO:
FROM:
DATE:
SUBJECT:
offlce of communlty development
ALL CONTRACTORS CURIENTLYL REGISTERED WITH THE
TOWN OF VAIL
TOWN OF VArL PUBLIC WORKS/COMMUNITY DEVELOPMENT
MARCH 15, 1988
CONSTRUCTION PARKING & MATERIAL STORAGE
fn sumrnary, Ordinance No. 6 states that it is unlawful for anvperson to litter, track or deposit any soil, rock, sand, debrisor material , including trash dumpsters, portable toilets andworkmen vehicles upon any street, sidewalk, alley or public
P1?9e or any portion thereof. The right-of-way on al1 Town ofVaiI streets and roads is approxirnately 5 ft. 6ff pavement.This ordinance will be strillfy enforcld by the town of VailPt:lplic works Departnent. persons found vi6rating this ordinancewirr be given a 24 hour written notice to remove said material .In the event the person so notified does not comply with thenotice within the 24 hour time specified, the pulfic WorksDepartment will remove said materiat at the expense of personnotified. The provisions of this ordinance sniff not beapplicable to construction, rnaintenance or repair projects ofany street or alley or any utilities in the right-a-way.
To review Ordinance No. 6 in ful1, please stop by the Town ofVail Building Department to obtain I copy. tiranf you for yourcooperation on this natter.
(i. e. contractor, owner)
tuwn u l|flI
75 soulh frontage road
vail. colorado 81657(303) 479-2L38 or 479-2L39 ofllce of communlty developmerrl
BUILDING PERI{IT ISSUANCE TIME FRAME
If this permi.t req.uires a Town of Vail Fire Department Approval,Engineel''s (Pyb] ic Works) reyiew and approval , a planning'Depariment
review or Health Department review, and a review by the BuildingDepartment, the estimated time for a total review may take as Iongas three weeks.
All commercial ('large or small) and a'll multi-famiiy permits willhave to follow the above mentioned maximum requirements. Residentialand smali projects should take a lesser amount of tjme. However, ifresidential on smalier projects impact the various above mentioneddepartments wi.th regard to necessary review, these projects mayalso take the three week period.
Every.attempt will be made by this department to expedite thispermit as s,qon as poss'ibl e.
I',. the undersigned, understand the p1 an check procedure and time
frame.
Project Name
ue!'rrqlr ' !J !st v rvrri,!ir ' sgrul
.'
Town of Vail
Plan Review Based onthe 1992 uniform CodeE OFFICE COPY
NAME:COATES BOILER DATE:1 /12/93
ADDRESS:21,99 CHAI4ONIX LN. CONTRACTOR:,JERRY SIBLEY PLUMBING
VAIL. COLORADO ARCHITECTTNONEOCCUPANCY:B2 ENGINEER:NONE
TYPE OF CONSTRUCT]ON: PLANS EXAMINER:C. FELDMANN
CORRECTIONS REQUIRED
lthe iteug listed bel.ow are not int,ended to be a cory)lece listing
of all Doseible code requireneatE in the adoDted codeg. rt i8 a
gruide to Eetected sectiong of, the codes. llhe following iE not to
be construed tso be an aDDroval of any violation of any of Ehe Dro-
"i"i"r" "f th" "doDt il.
1) COMBUSTTON ArR rS REQUTRED PER SEC.607 OF THE 1991 UMC.
2) ACCESS TO HEATING EQUIPMENT MUST COMPLY WITH SEC.7O3 OF THE
1991 uMC.
3) INSTALLATTON MUST CONFORM TO MANUFACTURES INSTRUCTIONS AND TO
APPENDIX CHAPTER 2L OF THE ]-99]- I]MC.
4) GAS LINE TEST AND INSPECTION IS REQUIRED BEFORE CONNECTION
oF ANY EQUTPMENT PER SEC.1206 OF THE 1991- UPC.
5) FTELD TNSPECTTON IS REQUTRED FOR CODE COMPLIANCE.
P1.- Review Baeed onthe 1992 Unifotm CodeE
o
FIELD COPY
NAME:COATES BOILER DATE:7 /12/93
ADDRESS:2199 CHAMONTX LN. CONTRACTOR:,JERRY SIBLEY PLUMBING
VAIL, COLORADO ARCHITECT:NONE
OCCUPANCY:B2 ENGTNEER:NONE
TYPE OF CONSTRUCTION: PLANS EXAMINER:C. FELDMANN
CORRECTIONS REOT'IRED
Tbe itetrs liEted below are not intended to be a corylet,e lieting
of all Dossible code requirenents in the adoDted code8. IE iE aguide to selected sections of ttre codee. 'lrhe following iE not uo
be const,rrred to be an approval of any violaEion of any of the Dro-,ri"i""" "f th. rd.DE i1.
1) COMBUSTION AIR IS REQUIRED PER SEC.6O7 OF THE 1991 UMC.
2) ACCESS TO HEATING EQUIPMENT MUST COMPLY WITH SEC,7O3 OF THE
1991 UMC.
3) INSTALLATION MUST CONFORM TO MANUFACTTJRES INSTRUCTIONS AND TO
APPENDIX CHAPTER 21. OF THE 1991 UMC.
4) GAS LINE TEST AND INSPECTION IS REQUIRED BEFORE CONNECTION
OF ANY EQUIPMENT PER SEC.1.206 OF THE 1991 UPC.
5) FIELD TNSPECTION 15 REQUIRED FOR CODE COMPLIANCE.
O
INSPECTION. F
PERMIT NUMBERTOF PROJECT
DATE
READY FOR
LOCATION:
INSPECTION:THUR (.Fil -:
tt ,.1\---'
TOWN OF
NAME
CALLER
TUES WED
//
BUILDING:
tr FOOTINGS / STEEL
PL
tr
tr
tr
tr
tr
tr
UMBING:
tr FOUNDATION / STEEL
UNDERGROUND
ROUGH i D,W.V.
ROUGH / WATERtr FRAMING
tr
tr
ROOF & SHEER
PLYWOOD NAILING GAS PIPING
INSULATION POOL / H. TUB
tr SHEETROCK NAIL
N FINAL tr FLNAL..-
ELECTRICAL:
tr TEMP. POWER
tr
tr
tr
ROUGH O EXHAUST HOODS
CONDUIT
P,FINAL
Y
E FINAL
ffuaoveo]ORRECTIONS:
O DISAPPROVED D REINSPECTION BEOUIRED
INSPECTOR
FriGsxop
AUG- 2-98 ltoFl 6 :59 5I BLEY TLUl'IE I N6 1Se5A2?5254
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( r!03 ) 827-5735
ri,.r i$(303)827-s234
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T0If{N0rvAnLy
Date '7-){;-?'7
o
Des
o
rmign Review Action Fo
TOWN OF VAIL
Proiect Namc:
Buildins Namc:
Project Dcscription;
Owner. Address and Phone:
Architect/Contact, Address and Phone:
Legal Description: Lot
Project Street Addrcss:
Comments:
rtrock 4 subdivision Vnru //'Qalli/S zoneDistrict?,fS
Zt17 ChatvtoNtx L*^, O,tr,, #V -r-
B'oarfiStaff Actioi\,=-.---_'--'-
Motion by:Vote:
Seconded bv:
tr Approval
u Disapproval
K Staff Approval
Condifions:
Town Planner
orc, 7' 78 a'/ DRB Fee pre-paid 2C, da-.
CENERAL INFORMATION
This application is for any pijcct rcquiring Dc.sign Rcvicw approval. Any projcct rcquiring dcsign rcvicw must
rcccivc Dcsign Rwicw approval prior to subrrritting for a buiiding perntit' Fo' spccific infomration' scc thc submittal
rcquirenrcnts for thc particular approvill that is rcquc.stcd. Thc apipiication cannot bc acccptcd trntil all thc rcquired
information is subnrittcd. Thc piojcct may also nced to bc rcvicwcd by thc Town Council and/or thc Planning and
Environmcntal commission. d.rign R.ni.rn Board approval cxpircs onc year aftcr final approval unless a
building pcrmit is issued and construction is startcd'
Qucstions? Cnt. Planning Staff at 479-2128
APPLICATION FOR DESIGN REVIEW APPROVAL
DESCRIPTION OF THE REQUEST:
o
Au o ls't AAo'e qenoe . ftrco t
B.LOCATION oF PROPOSAL: LOT:- BLOCK:-.-- FILINC:
PARCEL #:
ZONING:
PHYSTCALADDRESS: vN rr #1 , Llqq ctlAt'oNlY llNE
(Contact Eaglc Co. Asscssors Office at 970-328-8640 for parcel #)
-z"t
TOl'i[N OFVAIL
C.
D.
E.
F.
G.
NAME OF OWNER(S):
MAILING ADDRESS:3ts
z 3o3 - ?3 \-416
OWNER(S) SI GNATURE(S):
NAME OF APPLICANl':
MAILINC ADDRESS:t.
*oNu, 30 3 -+33 -
TYPE OF REVIEW AND FEE:
E Ncw Construction - $200 Constnrction of a new building'
tr Addition - $50 Includcs any addition whcrc squarc footagc is addcd to any rcsidcntial or
comnrcrcial building.
H.
FMinorAltcration -$20 [ncludcs minor changcs to buildings and sitc improvcnrcnts, such as,
rcroofing. painting. window additions. landscaping' fcnccs and rctaining
walls, ctc.
DRB fecs arc to be paid at the timc of subnrittal. Latcr. whcn applying for a building permit, please idcntify
thc accurate valuation ofthc projcct. Thc Town of Vail will adjust thc fec according to thc project valuation'
PLEASE SUBMIT THIS APPLICATION, AI,L SUBMITTAL REQUIREMENTS AND THE FEE TO THE
DEPARTMENT OF COMMUNITY DEVELOPMENT, T5 SOUTH FRONTAGE ROAD'
vArL, coLoRADO 8r6s7.
o
BUILDTNG MATERIALS:TYPE OF MATERIAL:
Roof
Siding
Othcr Wall Materials
Fascia
Soffits
Wiudows
Window Trim
Doors
Door Trint
Hand or Dcck Rails
Flucs
Flashings
Chintncys
Tra.sh Enclosurcs
Grccnhouscs
Rctaining Walls
Exterior Lighting**
othcr R.ePwabP PEc-LlN5,=tPft ,'THRaE Foaa +,tqt| KAtLt< /
F ENc€s ,D?_yf ffg ryri#*
+ Plca.se specify the manufacturcr's color, number aud attach? small color chlp
*+ All cxtcrior lighting must meet thc Town's Lighting ordinance 18.54.050(J). If exterior lighting is proposcd,
plca.se indicate tti nurnU., offixturcs and locations on a sqtaratc lighting plan. ]Oe.1tiff each fixturc type and providc
ih. huigi,t uboue grade, lumons output, lurninous area, ald attach a cut shect of the lighting fixtures'
COLOR:|
F-g0vrooo DECL
S tD(^Jq To
&.l-r,^Jf liftf"1\vrtON9
Updated 6/97
I pnoposeolnnnsclPrrc
Botanical Namc Comnron Namc Ouantity Sizci
PROPOSED TREES
AND SHRUBS:
EXISTING TREES TO
BE REMOVED:
GROUND COVER
SOD
SEED
IRRICATION
TYPE OR METHOD OF
EROSION CONTROL
*Minimum rcquircrncnts for landscaping: deciduous trccs - 2 inch calipcr
conifcrous trees - 6 fcct in height
shrubs - 5 gallons
Typc Square Footagc
OTHER LANDSCAPE FEATUdES (retaining walls, fcnccs, swimming pools, ctc') Ptease speciff' Indicate top and
bottorn elcvations of rctaining walls. Ma*imuir height of walls within the front sctback is 3 feet. Maximum height of
walls clscwhere on the propcrty is 6 fcct.
Updated619T
o
This fonn is to vcrify scrvicc availability and location for ncw construction and should bc uscd in conjunction
with prcparing your utility plan and schcduting installations. Thc location and availability of utilitics, w.hcthcr
thcy ilc main inrnk linc.s or'proposcd lines. muit bc approvcd and vcrificd by thc following utilitics for thc
accontpanying sitc Plan.
Authorizcd SiSnaturc Datc
U.S. Wcst Communications
| -tt00-922- l 987
468-6860 or 949-4530
Public Scrvicc ComPanY
949-5781
Gary Hall
Holy Cross Elcctric Assoc.
949-5892
Tcd Husky/John Boyd
T.C.I.
949-5530
Floyd Salazar
Eaglc Rivcr Watcr
& Sarritation District +
4't6-74110
Ftcd I {aslcc
* plcasc bring a sitc plan, floor plan, and clcvations whcn obtaining Uppcr Eaglc Vallcy Water & Sanitation
signaturcs. Firc flow tlccds tnust bc addrcsscd.
NOTES:
J.
l. If thc utility vcrification fornr has signaturcs fronr cach of thc rrtility companics, and no
commcnts arc madc dircctly on thc fomr, thc Town will prcsunre that thcrc are no problcms and
thc dcvclopnrcnt can Procccd.
Z. lfa utility company has conccms with thc proposed construction, the utility rcprcscntativc shall
note dircctly on the utility vcrification form that thcrc is a problcm which nccds to bc rcsolved'
The issuc should thcn bc,dctailcd in an attached lcftcr to thc Town of Vail. However, plcasc
kccp in nrind that it is thc responsibility ofthc utiliry conlpany and the applicant to rcsolvc
idcntificd problcms.
Thesc verifications do not rclicve thc contractor ofthc rcsponsibility to obtain a Public Way
permit fiorn thc Department of Public Works atthc Town of Vail. Utilitv locations must bc
obtaincd bcforc digging in any public right-of-way or easement within the Town of Vail. A
PRE-APPLICATION CONFERENCE
Updatcd 6/97
A prc-application confcrcncc with Town of vail staff is rcquircd. No applicition can bc acccptcd unless thc
mandatory prc-application nrcctir.rg has bccn conlplctcd. It is thc applicant's rcsponsibility to schcdulc this
ll.
ilt.
IV,
mccting by calling 970-479-212tt.
TIME REOUIREMENTS
Thc Dcsign Rcvicw Board ntccts orr thc lst and 3rd Wcdncsdays of cach month' A complctc application
forrn and-all accompanying nratcrial tnust bc acccptcd by thc Cornnrunity Dcvcloprrlent Dcpartntcnt a
minirnum of thrcc and a half (3 l/2) wccks prior to thc datc of thc DRB public hcaring.
REVIEW CRITERIA
your proposal will bc rcvrcwcd for compliancc with thc Dcsign Guidelincs as sct forth in Scction l8'54 of thc
Municipal Codc.
NOTE TO ALL APPLICANTS:
A. Ifa propcrty is locatcd in a mappcd hazard arca (i.c. snow avalanr:hc, rockfall, floodplain, dcbris
florv. wctland, ctc), a hazard study must bc subrnittcd arrd thc owncr nlust sign an allidavit
rccogrizing thc hazard rcport prior to thc issuance of a building pcrrnit. Applicants arc cncouragcd
to chcck with thc planning staft'prior to subrnittal of a DRB application to determinc thc relationship
ofthc propcrty to all nrappcd hazards'
B. Basic plan Shcct t'ornrat. For all surveys. sitc plans, landscapc plans and othcr sitc intprovcments
pltns, all of thc tbllowing must bc shown'
l. plan shcct sizc nrust bc 24"x36". For largc projccts. largcr plan sizc nray bc allowcd'
2. Scalc. 'fhc ntinirnurn scalc is l"=20'. All plans nlust bc at thc santc scalc.
3. Craphic bar scalc.
4. North arrow.
5. Titlc block. proicct nallrc, projcct addrcss and lcgal dcscription'
6. lndication of plan prcparcr, addrcss and phonc nuntbcr'
'1. Datcs oforiginal plan prcparation and all rcvision datcs'
tt. Vicinity tnap or location tnap at a soalc of l "= I '000' or largcr'
9. Shcct labcls and nttntbcrs.
l0 . A bordcr with a tninimum lcft sidc nrargin of l '5"'
I l. Nanrcs ofall adjaccrrt roadways.
12. Plan lcgcnd.
C. For new construction and additions, the applicant nlust stakc and tapc thc projcct sitc to indicate
propcrty lines, proposcd buildings and building comers. All trces to bc removcd nlust bc taped. The
applicant must cnsure that staking donc during thc winter is not buricd by snow. All site tapings
and staking must bc completcd prior to thc day of thc DRB mccting'
D. Applicmts who fail to appear beforc the Design Rcvicw Board on thcir scheduled mccting date and
who havc not a.sked in advance that discussion on their itcm bc postponcd, will have thcir items
rcmovcd fronr thc DRB agcnda until such time as the item has bcen rcpublished.
E. Ifthc DRB approves the application with conditions or modifications, all conditions of approval
must bc resolvcd prig to thc issuurcc of a building pcrmit'
Updatcd 6/97
STAFF APPROVAL
Thc Adrninishator lnay rcvicw and approvc Dcsigr Rcviw applications, approvc with ccrtain modifications'
dcny thc application, or may rcfcr thc applicationlo thc Dcsign Rcvicw Board for dccision' All staff
approvals arc subjcct to final approval by thc DRB. Thc following typcs of Desigr Rcvicw applications may
bc staff aPProvcd:
A. Any application for ar addition to an cxisting building that is co.nsistcnt with thc alchitcctuIal dcsign'
matcrials and colors of thc building. and approval has-bccn rcccivcd by an authorizcd rncmbcr ofa
condominium association. if applicablc:
B. Any application to modify an cxisting building that docs not significantly charrgc thc existing plancs
of thc building ano is gcrrcrally consiitent with thc arr:hitcchrral dcsign' nratcrials and colors ofthc
building, including. uJt not lirnitcd to extcrior building finish t'atcrials (c'g' storlcwork' siding' roof
matcrials, paint or stain,), cxtcrior lighting, canopics oi awnings. fcnccs..antcnnas' satellitc dishes'
windows, skylights. siding. minor comnrcrcial facadc improvcitrcnts, and othcr sinrilar modifications;
c. Any application lbr sitc improvcmcnts or rnodit'ications including' but not linritcd to' driveway
nro4ilicatiols. sitc grading, sitc rvalls. rcnroval or modifications to cxisting landscaping' installation
of acccssory structurcs or rccrcational lacilitics'
ADDITIONAL REVIEW AND FEES
A. If this application rcquircs a scparatc rcvicw by iuly local, statc or Fcdcral agcncy othcr than thc
Torvn of Vail. thc applicatio' icc shall bc incrcascd by $200.00. Examplcs of such rcview, may
includc. but arc not limitcd to: Colorado Dcpartnrcnt of Uigh*oy Acccss Pcrnrits' Army Corps of
Enginccrs 404. ctc'
B. Thc applicant shall bc rcsponsiblc for paying any publishing fccs which arc in cxccss of50% of thc
apptication l'ec. lf, at thc applicant's rcquest. any ntattcr is postponcd for hcaring' causing thc nrattcr
to tc rc-publishcd. thcn thc cntirc fcc for such rc-publication shall bc paid by thc applicant'
C, Applications dccmcd by thc Contnrunily Dcvclopnrcnt Dcp€rtnrcnt to havc dcsigrr, land usc or other
issucs which may havc a significant impact orr thc cornnrunity rnay rcquirc rcvicw by consultants in
addition to Town staff . Should a dctcrrrrination bc madc by thc Town staff that an outsidc consultant
is nccdcd, thc Conrnrunity Dcvclopmcnt Dcpartmcnt may hirc thc consultant' Thc Dcpartmcnt shall
cstimatc thc anrount of tnoncy ncccssary to pay thc consultant and this arnount shall be forwarded to
the Town by thc applicant at ihc timc oi filing un application' Expcnscs incuncd by the Torvn in. .
cxcess of thc amount forwarded by thc application .s-hall bc paid to thc Town by thc applioant within
30 days of notification bythcTown. Any cxccss funds will bc rehrned to thc applicant upon revicw
cornPlction.
VI.
Updated 6/97
f,
E[
gL
a
o
MINOR ALTERATIONS TO THE.EXTEiUOR OF BUILDINGS
AND SITE IMPROVEMENTS
GENERAL INFORMATION
This application applics to chaugcs nradc to a sitc or cxtcrior altcrations ofa building. Any altcration in
rvhich additional building squarc footagc is addcd rvill requirc an "additions" application.
I. SUBMITTAL REOUIREMENTS
Photos or sketches which clcarly convcy thc cxisting conditions.
Photos or skctchcs rvhich clearly convcy thc proposed building or sitc alteration(s).
All rclcvant spccifrcations for thc proposal including colors and rnaterials to be uscd.
Condonriniunr Associatiorr approval (if applicable).
If thc intcnt of thc proposal is not clcarly indicatcd, thc Adnrinistrator may dctcrminc that additional
nratcrials arc ncccssary for thc rcvicw of thc application.
,OI'i/N OF VAIL
?LIKE
+lQ?
Scale:
114" = 1 '-0"
New wall
3'H above new
decking
Existing
railroad tie
retaining
wall
Unit 9, Phase l, Pine Ridge
Exis{rng Grass
,/
New
Concrete
Slab
New
Concrete
Slab
Exrstrng Sidewa\K
Proposed deck and storage shed addition to Unit 9, Phase 1, Pine Ridge Townhouses,
2199 Chamonix Lane, Vail:
1) Replace existing concrete slabs with new slabs
2) Replace existing Landing (approx. 5'x 10')with new deck surface as indicated.
3) Construct new storage shed (7.5' x 4' x 8'H)- exterior surface to match siding on
townhouse.
4) Construct 3'H wall around new decking - exterior surface to match siding on
townhouse.
5) Move existing sprinklers to corners of new flower garden.
}VKE .1lq7
Scale:
114" = 1'-0"
Unit 9, Phase l, Pine Ridge
Earstrng Grass
Existing
railroad tie u,
retaining
wall
Elrstrng Sidewa\K
DUKE+/q+
New 3'H wall surrounding new deckExisting
railroad
tie
retaining
wall -----------r
New concrete slabs
Elevation showing proposed deck and
storage shed addition to Unit 9, Phase 1,
Pine Ridge Townhouses
oI -Dul+ Ezlal
il
.lt_l
il
Exiting Front Elevation - Unit 9,
Phase 1, Pine Ridge
Townhouses
Pnrdcdld Gorl RrryG hopGrfu
2qt7 No(t RdSc nodwc.t
V.lt, CO 11557
Fax Cover Sheet
DAIEI luly?f' lW
To TlnnyWillior PHOiE: 4?lh7rfi
To*rof VdlFtdgScnbca FA* 4TrU52
FnOM: Ccmic llolb PIIONB: (90) 476-3EU'}(nP FAr: (y'0) 4?6-138:i
n& DcD3r lrub, Pi!3 Ridgc Uuil 9 DccL Proponl
GC: Cildycilbrt
lfuohrr d ppr ictdq orr rtd: tl
Mesqr
Thc trhriry pjcs iElu& l|r infiorntrtioo ror ru!t6!cd m tlnir 9 Pic Rilgc 'li'*,r r irirrc. ox,Ed by
Dcbn Dukc. By reixity vre ( thoe of frur EOD oaobcrs wlirry) 6is DlrD h.s hrrr apprrwcd by rbc
Bord d Dtircqar of Plc tldp Tom ltdrct, sto cd o utllaix rll orbfuL rrcirieonral claqgcs.
lf you brt lly Ercdiru q aod furttcr infuudo, phc girc rc e cjt.
Ttrntyoc
TbIclu"
TO :lgVd gEergltEsE 80:rT L66tlazlla
I, L
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Permit Numbers Folice RccciPt Numbcrs
HOW PAID-I
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l'lisrel I aneous Cash
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