HomeMy WebLinkAboutPERMIT 500 Birch Ave Furnace & Gas Fireplace 2005-03-09Received Date
______
Town of Estes Park Permit Number_______
ReceivedBy /2 jZ Application for Miscellaneous Permit Office
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517 CopyGeneralInformation(970)S773731*Inspection Line (970)577-3731 *FAX (970)586-0249
Job Address:‘
L ()‘7,,3)k ,5,(f-r/(/L:b ,L1t -Owner Name:/?i-)Phone:
____________________
Address:5)I C )ka.D1 C i1
(Street)(City)(State)(Zip Code)
Contractor/Applicant:1y/r/tii k Town License #:
______Phone:____________
Address:/
(Street)(City)(State)(Zip Code)ii Residential Li Non-Residential
Li Air Conditioning Installation
D9Is Line (ft.)Li Reroof (Commercial —Pitched Only)LI9 Log Installation Roof Classification A B C NØNewFurnaceInstallation#of Squares______
Li New Water Heater Installation Li Reroof (Residential)
EJ Temporary Structure Use_________________#of Squares______
Time Period
__________________________
Li Siding
U Demo Structure EJ Windows
Li HAZARDS:Geo Wildfire Flood U Fire/Water Damage
C Drywall
Li Other
Descriptio of Work:/I-c iir iivw-e -<ja3 Mr/3Iad
Valuation (Total Cost of Material &Labor):$
I certify this application is true and correct and agree to perform the work described according to plans/specifications submitted,reviewed and approved,and comply withlocalordinances,stat 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,IUNDERSTATATIAMRESPONSIBLEFORANYFEESOREXPENSESINCURREDFORPLANREVIEW,PERMITS,INSPECTIONS AND OTHERFEESASSOADWITHTHISAPPLICATION.
Siatur
__________________________Date_______
nt Name
***0ffJJseOn1y***
—--Staff Comments:-
Permit Information
frmit Fee:1Z5
Census I?
County Tax 3 ZO
Building Official Date‘%,jj ,/__S”1”o Total:t 1g44
Revised 3/12/04