HomeMy WebLinkAboutPERMIT 1130 Brook Dr Furnace 2011-12-2012/20/2011 07:43 9795983189 MOUNTAIN VALLEY PLUM PAGE 91/01
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Permit Number M_,‘‘
Application for Miscellaneous Permit AI3l)IIcation F
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Department of 3uiilrliiug SaFety 1711 MiucUrognu-Avenue I’.t).BON 12)10 Istcs Pnrk CD 811517 joi
Gcnul Information &Inspection Line (970)577—3731 *FAX (970)586-0249 *wwwxtc!Lctejjn Permit lxpires ø*.
Job Addressj
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Owner Name:za ss_..SGctertc.Phone:6to 9033
Address:£c.
(Stale)Code)
Conti-aetor/Applicant:c Thflis.4 License #:Phone:S /0 fr.t
Address:‘-1 S\.Cc s___
Øtong-terni Residential (?30 days)LI Short-term Residential (<30 days)LI Commercial
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4tèplace Furnace U Gas Line (It)
C Replace Boiler U Replace Windows
C Replace I-lot Water Heater U Install Air Conditioninç
U Minor Plumbing C Temporary Structure Use
C Minor Remodel Time Period
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U Fireplace Insert —circle one:Gas,Wood,Pellet;U ()lhcr
Description ol’Work:£k%tt a l.4..L L Cç ..Z A—k j%.)Q
Velua&n (Total Cost ci’Material &Labor):$—
cerli fy hi ippi icill lOll 34 1ruc1 irili correct and agl-rc II)pLIriCirIll liii:work liCScrItlL:l,I lL:C:OIrliPtr lii ii lil5/1411&tiflC3ltil.iflil sahtiilltiicl Irviewed 01113 approved,nail comply with —.
liliall Qrdill:Iliccs,‘Ø;ilç 11113 ti:dt:riit tows is ‘veIl a;hi.iilrlirip ;111t.ic5 I ca’i r hal I [i;ivt:Ike property owner’s nolkorily slid perlOllillon In apply Ri:iii k permil .Additionally,1
UNDItRSTANI)FUAl I AM RFtSPONS!131.lt FOR ANY I’U31(5 OH I(XnI(SKS INCIJRRItI)FOR Pl,At RICYII1W,rlRM1’IS,LNSI’WFIONS AND OTHItRItESASSOCiAi’ttn Willi ‘FillS ,krPI,ICA’I’ION,Naict Ilie ivork bIrlIllIl—isistl Iy lIl pai’ElIil requuli-es 1:1w building be pruuvkled willi srtiolw nlni’nm cumplylng
with municipal codes.
Signunite ——
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Dale Jtzf_J!‘rail Nanic
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Received Date Zoi,L I L.to
ReceIved By
Town of Estes Park
Office
Copy
(Street)
qi,qj ?...c.*t
ICi >1
(StreetI (Citvl (Statel (Zip Code)
Inspection Checklist
U Address Posted
U Contractors Licensed
U Permit Packet Ava ileble
U Sale /\ecchs
***Office Use Only **,
Commctitst
U liqnipnwnt ,Alrccss
C]l]quipnient l..is:cri
U FitlI.liP1ei1t (.‘lenrpnces
EJ ‘on and Drain
LIT &P
U (‘iris Pipe
Cl Vital
LI (onthllsta
11w 1,(ranIer rage t at 1 Revised 7/14/2006 -CD