HomeMy WebLinkAboutPERMIT 1110 Brook Dr Vacation Home Life Safety 2018-03-14a
j ‘ceived Date Zoig -3-14-’Town of Estes Park Number VHLS________
LeceiveilBy_______Vacation Home Life Safety Survey Application Expires q-tI--i
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517 -—
Information (970)577-3726 *Inspection Line (970)577-3721 *FAX (970)586-0249 *n’s’s’estesor Permit Expires -‘
Job Address:///f 6yo,c’4t ft24fr t #of Bedrooms
Owner Name:4 *9/If Jo Z2(P Phone:‘940C4 Yért
Address:/7/Z /14WZ Ave /%lcfl/’hâf g
p (Street)(City ‘(State)(Zip Code)
Applicant:
___________________________________Town
License #:
______Phone:______________________
Address:
(Street)(City)(State)(Zip Code)
Description of Work:LIFE SAFETY SURVEY
I ceni this application is true,correct and will comply with local ordinances,state and federal laws as well as building codes,I certi 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,PE ITS,INSPECTIONS AND OTHER FEES ASSOCIATED WITH THIS APPLICATION.Note:The work authorized hy this permit
requires (he buildi be rovided h smoke alarms complying with municipal codes.
Signature Date Name
***Office Use Only ***
7114q &p”’1
$7
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Vacation Home:k”Large Vacation Home:Pert Fee:$200.00
Zone District County Tax:$0.00
teBuil>oIc!l,1 Da
,Total:$200.00
1/
MAR 15 2018
BY:.L)UJ
U:\Building Division\Fomis-Logs’Apps_Pennits_VHLS\.Apps,_VHLS Application.doc