HomeMy WebLinkAboutPERMIT 850 Black Canyon Dr Gas Fireplace 2011-03-31Mar 30 11 01 :39p Westover Construction 970-577-8462 Copy p.1
Received Date zo,q.o.3’!Town of Estes Park Permit Number M-L
Received fl 4v Application for Miscellaneous Permit Application ExpIresOU 1
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estee Park,CO 80517
General Information &inspection LAne (970)577-3731 FAX (970)5864)249 *www.estesnet.com Permit ExpLrea’Jl 1.-.i.11
Job Address:Lf Cnb-d
Owner Name:
_________________________________________________Phone:__________________________
Address:V)-i.i-.
(Street)(City)(Stale)(Zip Code)
Contractor/Applicant:(-)t”iSZ (2b Town License #:
______Phone:____________
Address:L&J t O 377
(Street)(City)(State)(Zip Code)
øLong-term Residential (30 days)U Short-term Residential (<30 days)I]Commercia1
U Replace Furnace C Gas Line (ft.)
U Replace Boiler C Replace Windows
C Replace Hot Water Heater I]Install Air Conditioning
C Minor Plumbing I]Temporary Structure Use______________
U Minor Remodel Time Period
_________________________
1?ireplace Insert —circle on Wood,Pellet;U Other
Description of Work:
Valuation (Total Cost of Material &Labor):$
I certify this application is tme and correct and agree to perform the work described according to plans/specifications submitted,reviewed and approvcd,and comply with
local ordinances,state and federal laws as welt as building codes.I certify that [have the property owners 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 TillS APPLTCATION.Nuts-The work authorized by thit permit requires the building be provided with smoke alarms complying
with municipal codes.
Signature
1L47 Dat3’rinNanse /7i9it f’1Y’
***Office Use Only ***
Inspection Checklist:
D Address Posted Equipment Access D T &P C Smoke Detectors
C Contraclors Licensed C Equipment Listed C Gas Pipe LI Rough Inspection
LI Permit Packet Available C Equipment Clearances LI Vent C Final Inspection
C Safe Access C Pan and Drain C Combustion Air
Coniments:
Census#-Constrctiort Type:Occupancy:
Date
Permit Fee:
County Tax:
/
ALARMS ARE REQUIRED**
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