HomeMy WebLinkAboutPERMIT 640 Columbine Ave Water Service 2013-10-28Office
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Received Date 2VI /O Town of Estes Park Permit Number M-iL /
Received By c e Application for Miscellaneous Permit Application Expires_4J11a/zt.214
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517
GeneraJ Information &Inspection Line (970)577-3726 *FAX (970)586-0249 *www.estes.ore Permit Expires t,T/2Of 4
Job Address:S/Q CcLu’E N E A VE
Owner Name:/2’7./V L-Y&/-/ELLEI&Phone:
______________________
Address:970 L3 Ol je’Jx T -
(Street)(City)(Stale)(Zip Code)
Contractor/Applicant:13a RL.t €lz XCi V P 7’/‘J,Z i’.’C Town License #:/t c Phone:970
2 /$26
Address:-u ‘N VV-d’id jê.L1If E P (‘C
(Street)(City)(State)(Zip Code)“Long-term Residential (30 days)El Short-term Residential (<30 days)LI Commercial
El Replace Furnace I]Gas Line (ft.)
El Replace Boiler LI Replace Windows
LI Replace Hot Water Heater LI Install Air Conditioning
El Minor Plumbing El Temporary Structure Use_______________
El Minor Remodel Time Period
__________________________
LI Fireplace Insert —circle one:Gas,Wood,Pellet;LI Other
Description of Work:e.3,4”it4er r t,s ìé.-e’iZ ck Thp h’[flcj ‘r h (‘b /a i ,-,.
A per tLr €9.eph.r-sest.
Valuation (Total Cost of Material &Labor):$
I certify this application is true and correct and agree to perform the work described according to plans/specifications submitted,reviewed and approved,and comply with
local ordinances,state and federal laws as well as building codes.I certify that I have the property owner’s authority and permission to appiy 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 THIS APPLICATION.Note:The work authorized by this permit requires the building be provided with smoke alarms complying
with municipal codes.
Signature L)’t4t Date //Li/i.3 PrintName y/)C).Qt.t i
***Office Use Oniy ***
Inspection Checklist:
El Address Posted El Equipment Access El T &P El Smoke Detectors
El Contractors Licensed El Equipment Listed El Gas Pipe El Rough Inspection
El Permit Packet Available El Equipment Clearances El Vent C Final Inspection
El Safe Access El Pan and Drain El Combustion Air
Comments:Permit Fee:
Census #Construction Type:Occnpancy:County Tax /0 50
Building a Date
2o/3—/a •28 Total:/27 75
**SMOKE ALARMS ARE REQUIRED**
P.IlL ti)
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