HomeMy WebLinkAboutPERMIT 1000 Big Thompson Ave Backflow 2017-01-06Received Date
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Town of Estes Park Permit Number M-o19 -/7
Received By a r Application for Miscellaneous Permit Application Expires
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Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517 /
General Information &Inspection Line (970)577-3726 *FAX (970)586-0249 *www.estes.ore Permit Expires 4/0/2/2.17
Job Address:/I%J6 4b 7E//d44fSdJ At’-er
Owner Name:M(4E 1t4C-’-/Phone:97O ste Ocfr?27
Address:K)dg A,-6 ‘ai’-9S&’,4Le-eS7ES ,4W/co gcjy
(Street)(City)(State)(Zip Code)
Contractor/Applicant:(27$’c J%TAtc.6 ‘14t’Town License #:217 Phone:_____________
Address:OI AIAL9AJ ‘W &tr,5/1ø7Ya cfti77
(Street)(City)(State)(Zip Code)
U Long-term Residential 30 days)U Shod-term Residential (<30 days)*gZonamerciaI
0 Replace Furnace C Gas Line (ft.)
U Replace Boiler C Replace Windows
o Replace Hot Water Heater C Install Air Conditioning
C Minor Plumbing C Temporary Structure Use_______________
o Minor Remodel Time Period
__________________________
o Fireplace Insert —circle one:Gas,Wood,Pellet;,Other
Description of Work:
Ifl5/z /7 &CI?E //rt.-J
Valuation (Total Cost of Material &Labor):$
I certi this application is true and correct and agree to perform the work described according to plans/specifications submitted,reviewed and approved,and comply with
local ordinances,state and federal laws as well as building codes.I certity that I have the property ownefs 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 ASSOC WITH THIS AP IC,$TIO -Note:The work authorized by this permit requires the building be provided with smoke alarms complying
with munici I code
Signature (—Date 1/6/7 Print Name /94u’i ta-C
***Office Use Only ***
Inspection Checklist:
0 Address Posted 0 Equipment Access C T &P C Smoke Detectors
0 Contractors Licensed 0 Equipment Listed C Gas Pipe 0 Rough Inspection
0 Permit Packet Available 0 Equipment Clearances C Vent 0 Final Inspection
0 Safe Access U Pan and Drain U Combustion Air
Comments:PermIt Fee:.97 45
Census II Construction Type:Occupancy:County Tax:2 lot
Bdint-OfOj Date Total:35.25
**SMOI(}ALARMS ARE REOUIRED**
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