HomeMy WebLinkAboutAPPLICATION Vacation Home Life Safety Inspection 1575 Fall River Rd #B1 of 1
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APR 2 5 2023
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Vacation Home Physical Address: 1575--(E) f-cdie. eive,,,e,,,d
,Yner Name: Axseiil___
Mailino Adores /s *eta e,,,,,Af .ii.e2.0 p,,,t-i& 3,5/4
(Street City (State
Email Address: / e6,1491,freNbaig,c014 L e write legibly) Phone
470 58'4 3/84
Property ManaoenLocal Representative: Gail -lla/h6a1"--1 ?
Email AddressiLVIONLie" ati,e64 pi, e write legibly) Phone
eila,231 .V.5q0
Number of Bedrooms per L._arimer Couilty Assessor- Data and Vacation Home License4pplication)
Identify Sleeping Areas other than Bedroon-is Ide n otfl.e family room c0
ription of Work: 2015 IRC AMENDMENT Section 327 LIFE SAFETY SU
I the homeowner, or Property Manager acting on behalf of the homeowner, certify the inform
is true and correct. I understand by signing and submitting this application, I agree to ha
inspected by the Building Official to ensure compliance with local ordinances. state and f(
building codes. Additionally. I understand that I am responsible for any fees associated with thi
Signature: Print Name -3--ocal 110561-, 1445
e wner/Property Manage!)
*
FFI 6 LY***
Building Official:
LSI Checklist
Initials:
Date:
Date:
Pern-ut Fee t?j, 141-2.1s4W2---
County Tax (LAID
Total
Issue permit number: VHLS: EXPIRES:
Email handoutspermit number to Owner/PropMgr/Town
Inspection Scheduled rCalendar,'Laserfiche'Town Cler,</CD: