HomeMy WebLinkAboutAPPLICATION Vacation Home Life Safety Inspection 401 Riverside DrI RECEIVED1
PC 1 2022
BY:TIME:
Vacation Home Physical Address:QS
________
Owner Name:
____
On
Mailing Address:1U--
(Streh City1 (S ite)(Zip Code)
Email Address:
_____________
\(çv pI:;ewritelegibIy)Phone:Q7O ‘7’37J
Property Manager/Local Representative:Q’.
______-
Email Address:pl .e write legibly)Phorn
Number of Bedrooms (per Larimer County Assessor Data and Vacation Home License Applicati In)
Identify Sleeping Areas other than Bedrooms (den,office,family room,etc)
_________________________________—
Description of Work:2015 IRC AMENDMENT Section 327 LIFE SAFETY URVEY
I the homeowner,or Property Manager acting on behalf of the homeowner,certify the infornation on this application
is true and correct.I understand by signing and submitting this application,I agree to iave the nbove property
inspected by the Building Official to ensure compliance with local ordinances,state ant federal laws as well as
building codYdUitionall I und tand that I am responsible for any fees associated with his appIic;.tion.
Signature:
___________—
mt Name U 10F Datc /i/
(1J3owne!:/Ptoperty Mana get)
***OFFICE USE ONLY***
Permit Fee:$200.00
County Tax:$0.00
Building Official:Date:Total:tJtttfr?fJ77 IJf $200.00
LSI Checklist
Initials:Date:Issue permit number:VHLS:EXPIRES:--_________
Email handouts/permit number to Owner/Proygr/Tov.iClerk
jpçtion Scheduled (Calendar/Laserfiche/Town CIerk/C:)-VHLS Database)
Inspection foHow up to Owner/PropMgr/Town Clerk(9Laserfiche)-____
Final Inspection Schedule±CaIendar/Laserfiche/Town t erk/CD-VH LS Databas
Results of Final Inspection entered in Laseruiche
-
Issue CO to Owner/PropMgr/Town Clerk/Property File
Field Approved forCertificate of Occupancy by:Date:—___________
RETURN TO:townclerkestes.org,Town Clerk’s Office,P.O.Box 1200,Estes Park,CO 80517
Town of Estes Park
Vacation Home Life Safety Inspection A
Co
Updated 07/2021