HomeMy WebLinkAboutLSI APPLICAITON 522 Promontory DrRECEIVED
Town of Estes Park
L Vacation Home Life Safety Inspection Al pIicatP82U22
BY:2’JtD TIME:cPL3
Vacation Home Physical Address:52.2_iO,1i sl’’t’I(4-rs C
OwnerName:ç
MailingAddress:/>9/5 MA’s pr OTh.C4r.
(Street)(City)(State)(Zip Code)
Email Address:tCH t/)/6 t G,’jATi-Cl)Th (please write legibly)Phone:/CZ 2G3 3(
Property Manager/Local Representative:
__________________________________________________________________________
Email Address:
_________________________________________________
(please write legibly)Phone:_______________________
Number of Bedrooms (per Larimer County Assessor Data and Vacation Home License Application)3
Identify Sleeping Areas other than Bedrooms (den,office,family room,etc)‘
Description of Work:2015 IRC AMENDMENT Section 327 LIFE SAFETY SURVEY
I the homeowner,or Property 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 Building Official to ensure compliance with local ordinances,state and federal laws as well as
building codes.Additio ly,Iundrtrd that I am responsible for any fees associated with this application.
Signature:
________________________
Print Name ,2cqi,rcg Date:
________
***OFFICE USE ONLY***
Permit Fee:$200.00
County Tax:$0.00
Building Official:Date:Total:y{c2k.10123 t.QtIb/’t.27 Q1f\$200.00
LSI Checklist
Initials:Date:Issue permit number:VHLS:EXPIRES:
Email handouts/permit number to Owner/PropMgr/Town Clerk
Inspection Scheduled (Calendar/Laserfiche/Town Clerk/CD-VHLS Database)
Inspection follow up to Owner/PropMgr/Town Clerk (via Laserfiche)
Final Inspection Scheduled (Calendar/Lasertiche/Town Clerk/CD-VHLS Database)
Results of Final Inspection entered in Laserfiche
Issue CO to Owner/PropMgrlTown Clerk/Property File
Field Approved for Certificate of Occupancy by:Date:
RETURN TO:towncIerk(ãestes.orp,Town Clerk’s Office,P.O.Box 1200,Estes Park,CO 80517
Updated 07/202 1