HomeMy WebLinkAboutVACATION HOME LIFE SAFETY SURVEY 215 Big Horn Dr 2019-01-04jWacationHomeLifeSafetySurveyApplicationExpiresZt/;—;\c\ofBuildingSafety170MacGregorAvenueP.O.Box1200EstesPark,CO80517Information(970)577-3739*InspectionLine(970)577-3722*www.colorado.liov/townofestespark‘2-ISPjicttoyk1ThrivtOwnerName;U1flCiVOJMavAddress:162-IFlic4e_AWWu[cii’spcUc,J(City)(State)(ZipCode)(frkt)(City)(State)—(ZipCode)Numberofbedrooms(asperLarimerCountyAssessordataandVacationHomeRegistrationform)____________Identifysleepingareasotherthanbedrooms(den,office,familyroom,etc)_____________DescriptionofWork:2015IRCSection327LIFESAFETYSURVEYIcertifythisapplicationistrue,correctandwillcomplywithlocalordinances,stateandfederallawsaswellasbuildingcodes.IcertifythatIhavethepropertyowner’sauthorityandpermissiontoapplyforthispermit.Additionally,IUNDERSTANDTHATIAMRESPONSIBLEFORANYFEESOREXPENSESINCURREDFORPLANREVIEW,PERMITS,INSPECTIONSANDOTHERFEESASSOCIATEDWITHTHISAPPLICATION.Note:Theworkauthorizedbythispermitrequiresthebuildingberovidedwithsmokealarmscomplyingwithmunicipalcodes.SignaturejPrintNameicALrcDate//44c,qPermitFee:$200.00/i/9CountyTax:$0.00BuildingOfficial:Date:Total:$200.00***OfficeUseOply***rE)ZOflULtLs_;LHome:__________________________FieldApprovedforCertificateofOccupancyVacationHome:SpecialConditionsLargeVacationHome:___________Approvedby:Date:TownofEstesParkPCrIIiLNumberVHLSCC)aJobAddress:(Street)Emailaddresss±roflqCkVOíaApplicant:______Phone:11°2’L-fMavsKcAddress:2-15131c1HornCo5OS/4b.Cjfli(iIi(pleasewritelegibly)—Phone110Lf32.’ownBusinessLicense#:_______Emailaddress:5troEstcsPor(00atoV’flOII-(C1/\4pteasewritelegibly)P!miYMLpp_YiiLltien9urrnl