HomeMy WebLinkAboutPERMIT 732 Black Canyon Dr Vacation Home Life Safety 2018-05-06_____
Town of Estes Park
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Vacation Home Life Safety Survey Application
4 Oj5j00 of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517
—Information (970)577-3739 *Inspection Line (970)577-3722 *www.colorado.2ov/townofestespark
(Street)cJ (City)
Email address:IS+obbs(&I-aser ta nS,Cawt (please “rite egibly)
Applicant:4ii gg tj PhoneSbB-53O-O54?Town Business License #:
Address:390/Sic 4e C.7L ...A6r5 P%±r A.JEr•6?iO/
(Street’r I (City)(Slate)-(Zip Code)
Number of bedrooms (as per Larimer County Assessor data and Vacation I-Tome Reistration form)
Identify sleeping areas other than bedrooms (den.oftice,family room,etc)
__________________________________
Description of Work:2015 IRC Section 327 LIFE SAFETY SURVEY
I certil5’this application is true,correct and will comply with local ordinances,state 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,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
permil requires the building be provided with smoke alarms complying with municipal codes.
Signature
Field Approved for Certificate of Occu
Print Name LAfl%SE¼IJAS Date
Owner Nanic:
Permit Number VFILS “1 C
Expires
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JobAddress:‘73-2 Sfk <itNjfl.f Th.nic Eshs Mq4ek.
Address:Siisa rberru
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________________________Phone:
33-’Q -ow
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Alt
(State)(Zip Code)
Email address:I S4W Wen knt nSa $%.r ‘-i—-
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(please write legibly)
‘Permit Fee:$200.00
4 -//r &County Tax:S0.00
Building Official:Date:Total :S200.UU
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Approved by:Date:
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