HomeMy WebLinkAboutPERMIT 540 Birch Ave Fire Stopping 2011-03-23...)I
Job Address:.%cii íA i)-j
Owner Name:ii3 //c.cjlV7,i Phone:
Address:L/t [31 rc1’
(Street)(City)(State)(Zip Code)
Contractor/Applicant:iJe R /1J4//F/14,1f (1Nr*wn License #:IZP Phone:7G //C
Address:it)L/7 LVi1-1-i Ip c5$5 /,‘k’
(Street)I (City)(State)(Zip Code)
LI Long-term Residential (30 days)EJ Short-term Residential (<30 days)tomniercial
LI Replace Furnace LI Gas Line (ft.)
LI Replace Boiler LI Replace Windows
LI Replace Hot Water Heater LI Install Air Conditioning
LI Minor Plumbing LI Temporary Structure Use_______________
Q Minor Remodel Time Period
EJ Fireplace Insert —circle one:Gas,Wood,Pellet;LI Other
I certify this application is trite 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 certify that I have the property owners authority and permission to apply for this permit.Additionally,I
UNDERSTAND THAT I AM RESPQNSIBLE FOR ANY FEES OR EXPENSES INCURRED FOR PLAN REVIEW,PERMITS,INSPECTIONS AND OTHER
FEES ASSOCIATED WITH THIS,fPPI.4CATION.Note:The work authorized by this permit requires the building be provided with smoke alarms complying
with niunicipal codes.////-.
Signature !Date))’//Print Name ai L
***Office Use Only ***
Inspection Checklist:
LI Address Posted LI Equipment Access D T &P D Smoke Detectors
LI Contractors Licensed C Equipment Listed C Gas Pipe C Rough Inspection
C Permit Packet Available C Equipment Clearances LI Vent C Final Inspection
C Safe Access C Pan and Drain C Combustion Air
Comments:Permit Fee:3
Census #i(.Construction Type:Occupancy:County Tax:3.2.-a
DateBu11dIng,,Total:
____
érYC-U
Recei’ed Date .ZO i3’Town of Estes Park Permit Number M2JL -I
2-0u
ReceivedBy ‘-Application for Miscellaneous Permit Application Expires -
Department of Building Safety 170 MacGregor Avenue P.O.Box 1290 Estes Park,CO 80517 2-O I
General Information &Inspection Line (970)577-3731 FAX (970)586-0249 ws u.estesueLcom Permit Expires _fI I
3
Description of Worlc:
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