HomeMy WebLinkAboutVH Life Safety Survey 1065 Acacia Dr 2018-11-13ce
Received Dote
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Tovn of Estes Park Number VHLSLLL1L
Receivj4
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Vacation Home Life Safety Survey Application Expires S[i1ij
Division of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517
Information (970)577-3739 *inspection Line (970)577-3722 *n.coIouado.2o’/to”to1 estesinirlct7‘
JobAddress:fOc6 -eaca J)c ‘C zS+-ej Park-Lo g0Sr7
Owner Name:-CAWS crv Phone:at6L-4’wg
Address:4C V\MUer’T’rctd (3 cti3--eJ ‘1;i&i,o
(Street)(City)‘(State)(Zip Code)
Email address:.€c-k earktv\I.t ich (please sritc legibly)
Applicant:3 XtVV PCS Phone:(4own Business License #:
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Address:tk (tetcJ
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Street)(City)(Slate)(Zip Code)
Email address:acL-’ei._ct-A r 4 L \“A Ic-V 7iease write legibly)
Number of bedrooms (as per Larimer County Assessor data and Vacation Home Registration form)2
Identify sleeping areas other than bedrooms (den,office,family room,etc)
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Description of Work:2015 IRC Section 327 LIFE SAFETY SURVEY
I certtfy this application is true,correct and wtll comply with local ordinances,state and federal laws as well as building codes.
I certify that I have the property owner’s authority and permission to apply for this permit.Additionally,I UNDERSTAND
THAT i AM RESPONSIBLE FOR ANY FEES OR EXPENSES INCURRED FOR PLAN REVIEW,PERMITS,
INSPECTIONS AND OTHER FEES ASSOCIATED WITH THIS APPLICATION.Note:The work authorized by this
permit requires the building be provided with smoke alarms complying with municipal codes.
Signature Print Name05 ‘&oa ate 1k
“Permit Fee:$200.00//i County Tax:
Building Official:Dale:Total :$200.00
***Office Use Only ***9t e4cIc fZ 0
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Home:V Field Approved for Certificate of Occupancy
Vacaiton Home:Specia)Conditions
Large Vacation Home:
(‘Approved by:Q,1’Date:
U:\Building Division\Forms-Logs\Apps_Permits_VHLS\Apps_VHLS Application Current.doc