HomeMy WebLinkAboutLSI APPLICAITON 1911 Crags CtRECEIVEDTownofEstesPark
Vacation Home Life Safety Inspection A )plieat[on 4 2022
BY:TIME:
Vacation Home Physical Address:/q)J Ct6f1s’Ct’,‘t —
Owner Name://
Mailing Address:4o ‘si”S+tfrhord
(Street)(City)(State)(Zip Code)
Email Address:19!JDdC/fl02/?DII’?fr?atI (please write legibly)Phone:77D-4 7%
Property Manager/Local Representative:t27€7/’7 u119Y(a
Email Address:t4/h2p/?a f/14/f.cO/n (please write legibly)Phone:7iU ZZ’(1ç/
Number of Bedrooms (er Larimer County Assessor Data and Vacation Home License Application)S
Identify Sleeping Areas other than Bedrooms (den,office,family room,etc)
__________________________
Desription of Work:2015 IRC AMENDMENT Section 327 LIFE SAFETY SURVEY
I the homeowner,or P1roperty Manager acting on behalf of the homeowner,certify the information on this application
is true and correct.I understand by signing and submitting this application,I agree to have the above property
inspected by the BuiIing 9ff icj,af’to ensure compliance with local ordinances,state and federal laws as well as
building codes.Ad oi I derstand that I am responsible for any fees associated with this application.
Sig nature Print Name 7boy ñDk Date:
(I4omeown perty Manager)
***OFFICE USE ONLY***
Permit Fee:$200.00
County Tax:$0.00
BuildingOfficial:Date:Total:%cO fV6 (—LYz.._i%’€J()$200.00
LSI Checklist
Initials:Dat :Issue permit number:VHLS:EXPIRES:
Email handouts/permit number to Owner/PropMgr/Town Clerk
Inspection Scheduled (Calendar/Laserfiche/Town ClerkICD-VHLS Database)
Inspection follow up to Owner/PropMgr/Town Clerk (via Laserfiche)
Final Inspection Scheduled (Calendar/Laserfiche/Town ClerkICD-VHLS Database)
Results of Final Inspection entered in Laserfiche
Issue CO to Owner/PropMgrfFown Clerk/Property File
Field Approved for Certif cate of Occupancy by:Date:
RETURN TO:to mcIerkestes.orcf,Town Clerk’s Office,P.O.Box 1200,Estes Park,CO 80577
Updated 07/2021