HomeMy WebLinkAboutPERMIT 540 Chapin Ln Water Heater 2017-01-18Town of Estes Park 9?YmitNumberM-O1 rl
Received By 3V’Application for Miscellaneous Permit Application Expires 7/i /‘
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517 &../-1GeneralInformation&Inspection Line (970)577-3726 *FAX (970)586-0249 *www.estes.ortz Permit Expires 1°
Job Address:1SLià (*Va pn t
Owner Name:D i C Phone:-Q9o LU ‘3
Address:h9ñ 1c nt 6’YQf &D.
(Strethl (City)(State)(Zip Code)
Contractor/Applicani R I Town License #:Pho7 -\9
Address:g fln @0
(Streeti (City)(State)(Zip Code)
u-Long-term Residential (?30 days)C Short-term Residential (<30 days)C Commercial
Li Replace Furnace Li Gas Line (ft.)
C Replace Boiler El Replace Windows
Replace Hot Water Heater El Install Air Conditioning
C Minor Plumbing C Temporary Structure Use________________
C Minor Remodel Time Period
__________________________
C Fireplace Insert —circle one:Gas,Wood,Pellet;C Other
Description of Work:
Valuation (Total Cost of Material &Labor):S 12 0/
certify this application is true and coned and agree to perfonn the work described according to plans/specifications submitted,reviewed and approved,and comply with
local ordinances,slate and federal laws as well as building codes.I certify thai ltia e the properly owner’s authority and permission to apply f,r 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 stork authori,ed by Ibis permit requires the building be provided with smoke alarms complying
with municipal codes.
Stgnature Date’__Print Name
,
***Office Use Only ***
Inspection Checklist:
U Address Posted U Equipment Access C T &P U Smoke Detectors
C Contractors Licensed C Equipment Listed C Gas Pipe C Rough Inspection
C Pennit Packet Available C Equipment Clearances C \ent C Fitial Inspection
C Safe Access C Pan and Drain C Combustion Air
Conanaents:Permtt Fee:‘-/1 qo
Construction Type:Occupancy:
County Tax:
‘-2 Dalez../-7r-/7 Total:
%*SMoj(j ALARMS ARE REOUIRED**
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Census #