HomeMy WebLinkAboutAPPLICATION Vacation Home Life Safety Inspection 223 Virginia Drthtw-•ReceivedDate’_-TownofEstesParkPermitNumberVHLSIt)C-jReceivedBy________VacationHomeLifeSafetySurveyApplicationExpires________DivisionofBuildingSafety170MacGregorAvenueP.O.Box1200EstesParlçCo80517Information(970)577-3739*inspectionLine(970)577-3722*www,colorado.gov/tonofestesparkJobAddress:Va€41,,,,gtOwnerName:Phone:_________________Address:Zy,e4zoy,4’12CC57Z6,twkc8o5i(Street)(City)(State)(ZipCode)Emailaddress:kiVe7’Vv’t/tjst@,u7.C(pleasewritelegibly)Applicant:Je..cPhone:_____________TownBusinessLicense#:________Address:210oC7vM&ije/aae_80/d—1coosi(Street)(City)(State)(ZipCode)Emailaddress:aa.t(pleasewritelegibly)Numberofbedrooms(asperLarimerCountyAssessordataandVacationHomeRegistrationform)IIdentifysleepingareasotherthanbedrooms(den.office,familyroom,etc)/—z.-i/‘q/&cn4DescriptionofWork:2015IRCAMENDMENTSection327LIFESAFETYSURVEYIcertifythisapplicationistrue,correctandwillcomplywithlocalordinances,stateandfederallawsaswellasbuildingcodes.IcertifythatIhavethepropertyownersauthorityandpermissiontoapplyforthispenniLAdditionally,IUNDERSTANDTHATIAMRESPONSIBLEFORANYFEESOREXPENSESINCURREDFORPLANREVIEW,PERMITS,INSPECTIONSANDOTERFEESASSOCIATEDWITHTHISAPPLICATION.SignatureQPrintNameDate(JPermitFee:$200.00/c”—,L/,CountyTax:$0.00BuildingO?ficial:Date:Total:$200.00***SeeBack/)lFieldApprovedforCertificateofOccupancyby:Date:U:\BuildingDivision\Forms-LogstApps_Perniits_VHLS\Apps_VHLSApplicationCurrent.doc