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APPLICATION Vacation Home Life Safety Inspection 421 Aspen Ave 2021-12-03
TownofEstesParkRECEIVEDVacationHomeLifeSafetyInspectionAlpIicatjpji3Z021TIME:VacationHomePhysicalAddress:42tAsp-cnAvnu-)ES-t’.411CO905tThOwnerName:ER-ic-Pf+PcP-rJMailingAddress:2hD5TtuzNockxL41.BcshACDO3O(Street)fCity)(State)(ZipCode)EmailAddress:J.0tenG,C1VV.4ICt’IYI(pleasewritelegibly)Phone:(40(e”)Zb—IOThPropertyManager/LocalRepresentative:C_ka.rte.-SEmailAddress:te.ttaiI€ct3.CMrY9(pleasewritelegibly)Phone:(:1.0’)1193t’i3NumberofBedrooms(perLarimerCountyAssessorDataandVacationHomeLicenseApplication)3IdentifySleepingAreasotherthanBedrooms(den,office,familyroom,etc)IS1]PDescriptionofWork:2015IRCAMENDMENTSection327LIFESAFETYSURVEYIthehomeowner,orPropertyManageractingonbehalfofthehomeowner,certifytheinformationonthisapplicationistrueandcorrect.Iunderstandbysigningandsubmittingthisapplication,IagreetohavetheabovepropertyinspectedbytheBuildingOfficialtoensurecompliancewithlocalordinances,stateandfederallawsaswellasbuildingcodes.Additinaly,IunderstandthatIamresponsibleforanyfeesassociatedwiththisapplication.Signature:________________________PrintNameaddDate:________(fromonet/PropertyManager)***OFFICEUSEONLY***PermitFee:$200.00CountyTax:$0.00BuildingOfficial:Date:Total:‘ç’1L11O{’1b2k’jJF$200.00LSIChecklistInitials:Date:Issuepermitnumber:VHLS:EXPIRES:Emailhandouts/permitnumbertoOwner/PropMgr/TownClerkInspectionScheduled(Calendar/LaserNche/TownClerk/CD-VHLSDatabase)InspectionfollowuptoOwner/PropMgr/TownClerk(viaLaserliche)FinalInspectionScheduled(Calendar/Laserfiche/TownClerk/CD-VHLSDatabase)ResultsofFinalInspectionenteredinLaserhcheIssueCOtoOwner/PropMgr/TownClerklPropertyFileFieldApprovedforCertificateofOccupancyby:Date:RETURNTO:towncIerkestes.org,TownClerk’sOffice,P.O.Box1200,EstesPark,CO80517Updated07/2021