HomeMy WebLinkAboutFORM VH & B&B Withdrawal and Utility Rate ChangeRevised 11/2022
Vacation Home/Bed & Breakfast Withdrawal
& Utility Rate Change Form
**To be completed by the Owner of Record**
DATE OF REQUEST:
HOMEOWNER NAME:
LOCATION ADDRESS: Unit #
TELEPHONE NUMBER:
EMAIL:
REASON FOR WITHDRAWAL: Check all that apply
No longer operating New owner Life Safety Inspection
Workforce Housing Linkage Fee Increase in Lodging & Accommodations Tax
License not actively used Too many regulations Other
By signing below, you are confirming the above address is no longer securing a
vacation home /bed & breakfast license and request the utility rates be changed to
residential. Any future use as a vacation home/bed & breakfast will require a new
application.
SIGNATURE:
Internal Use Only
(Do Not Write Below This Line-This section to be completed by staff)
To be completed by Utility Billing:
Individual Water Meter: Yes
Location ID: Date of Conversion:
Utility Billing Department Approval:
To be completed by the Town Clerk’s Office:
VH: B&B
License number: Date made inactive:
Department Notification: ComDev/Building: CEO: LODGINGRevs:
Initials:
RETURN TO: townclerk@estes.org, Town Clerk’s Office, P.O. Box 1200, Estes Park, CO 80517