HomeMy WebLinkAboutPERMIT 1219 Brook Dr Gas Line 2017-11-10Received p52ti1_11-10 Town of Estes Park Pern,llNtiinber
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ReceivedBy .)v Application for Miscellaneous Permit Appllcatlonrxplret”’L/t
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517
General information &Inspection Line (970)577-3726 *FAX (970)586.0249 *w.wsstvs.ore Permit Expires
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Job Address:,Lr)/1()NJ D1 (c’)S)7
Owner Name:a (c’*A 2 L L Phone:-/)(/
Address:lI9 UYLNcC br ‘*Prv fl);a’i
(Sired)(City)(Stale (Zip Code)
ContracIor/Applicantft C Town License #:7&C>Phone:-9
Address:J C )Vi’i[4 F (KO)R
(Sircet)(City)(State)(Zip Code)
Ø.Long-terrn Residential (30 days)0 Short-term Residential (<30 days)0 Commercial
C Replace Furnace SGas Line (‘-1w ft.)
C Replace Boiler C Replace Windows
C Replace Hot Water Heater 0 Install Air Conditioning
C Minor Plumbing C Temporary Structure Use_________________
C Minor Remodel Time Period
____________________________
C Fireplace Insert —circle one:Gas,Wood,Pellet;0 Other
Description of Work:i2 (C-\.
Valuation (Total Cost ofMaierial &Labor):$‘1 Ai,&ftk-isv-,,or-,‘itA —3B;—17
certify this application is true and correct and agree in perform the work dcscnbed according to plans/specifications submitted.revicwcd and approved,and comply will,
local ordinances,stole and I dei-al laws as wcll as building codes.I eenit’that I have he properly owner’s authority and permission to apply tbr this permit.Additionally.I
UNDERSTAND TIIAT I AM RESPONSIBLE FOR ANY FEES OR EXPENSES INCURRED FOR PLAN REVIEW,PERMITS,INSPECTIONS ANDOTHER
FEES ASSOCIATED WITH THIS APPLICATION.Note:the work authorized by liii,permit requIres the buIlding be provided with smoke alarms complylag
will.munici I codes,
Signature Dale I IL jl9print Name nd,R
***Office Use Only ***
Inspection Checklist:
C Address Posted C Equipment Access C T &p 0 Smoke Detectors
El Contractors Licensed U Equipment Listed C Gas Pipe C Rough Inspection
C Permit Packet Available C Equipment Clearances C Vent El Final lnspeetiop
C Safe Access U Pan and Drain C Combustion 2-cComrnentsPermitFee:
Census #Construction Type:Occupancy:
County Tax:
I)ate /Total:20.00
**SMOKE ALARMS ARE REOUIRED**
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