HomeMy WebLinkAboutPERMIT 517 Big Thompson Ave Backflow 2017-12-12Received nate2’f7:flht Town of Estes Park Odj2’ermu Number M______
Received By 1k\)Application for Miscellaneous Permit Application Expires’1’0
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,Co 80517
Information (970)577-3726 *Inspection Line (970)577-3721 *FAX (970)586-0249 *www.estes.org Permit Expires —
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Owner Name:Li)k&c-feV”1’1 6—vvt Phone:?o ‘5ZL ‘&-c
Address:r/):±w1
/(Street)kj II (City)(State)(Zip Code)
Contractor/Applicant:fSS L_-Town License #:
_______Phone:
$2 44-6fkCJ
Address:P0
(Street)(City)(State)(Zip Code)
D Long-term Residential (30 days)C Short-term Residential (<30 days)Jtonimerciai
D Replace Furnace C Gas Line (ft.)
C Replace Boiler C Replace Windows
C Replace I-Tot Water Heater C Install Mr Conditioning
C Minor Plumbing C Temporary Structure Use_______________
C Minor Remodel Time Period
__________________________
o Fireplace Insert —circle one:Gas,Wood,Pellet;WOther 4c_F1cw v12a1a-rt&..
Description of Work:—C’tO I /*rS+?’t rt c 1
Valuation (Total Cost of Material &Labor):$()
certify this application is true and correct and agree to perform the work described acconling to plans/specifications submitted,reviewed and approved,and comply with
local ordinances,state and federal laws as well as building codes.I certify chat 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:z-
Inspection Checklist:
C Address Posted C Equipment Access C T &P C Smoke Detectors
C Contractors Licensed El Equipment Listed C Gas Pipe C Rough Inspection
El Permit Packet Available C Equipment Clearances C Vent C Final Inspection
C Safe Access C Pan and Drain C Combustion Air
Comments:Permit Fee:(p 3,/
County Tax:6.Census #Construction Type:Occupancy:
DateB7MfOa4M%’t Total:
DEC 12U 1•7 —
U:\Buildirig Divisiori\Forrns\AppIicationsOTCMisceIianeous\MiscelIaneous 2012.03.29.doc