HomeMy WebLinkAboutPERMIT 650 Columbine Ave Water Service 2010-09-28Received Date iQLQQ.Town of Estes Park 01Ce Permit Number M-010+10COPY
c”—Application for Miscellaneous Permit Application Expires 3-Received By
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517 2.o u
General Information &Inspection Line (970)577-3731 °FAX (970)586-0249 *wwii.estesnet.cons Permit Expires 3 2.
JobAddress:(,/\‘O!’2-oOO(p
Owner Name:;‘ir Ji.sJ Phone:?C.3 I.//y
Address:)I 2-0 FOL.-5ow (3O.At.-()(i/1—
(Street)(City)(State)(Zip Code)
Contractor/Applicant:A -i J .Town License #:J?51 Phone:
Address:/1 iSf &Srs
(Street)(City)(State)(Zip Code)
D Long-term Residential (30 days)Short-term Residential (<30 days)D Commercial
D Replace Furnace D Gas Line (ft)
D Replace Boiler D Replace Windows
D Replace Hot Water Heater D Install Air Conditioning
D Minor Plumbing C Temporary Structure Use________________
C Minor Remodel Time Period
C Fireplace Insert —circle one:Gas,Wood,Pellet;4l Other .
Description of Work:
Lr1 FutCI
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 pennission to apply 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 codey
Signature s ---‘-Date 2 7 -IC Print Name )tS ArI
Office Use Only ***
Inspection Checklist:
D Address Posted 0 Equipment Access 0 T &P 0 Smoke Detectors
0 Contractors Licensed 0 Equipment Listed 0 Gas Pipe 0 Rough Inspection
C Permit Packet Available C Equipment Clearances C Vent C Final Inspection
C Safe Access C Pan and Drain C Combustion Air
Comments:Permit Fee:3 2.
Census #Construction Type:Occupancy:q ,tf CotrntyTax:1oqo
Buildin icial Date/(ff/Total:
V
**SMOKE ALARMS ARE REQUIRED**
VServeraomm the Counter Page 1 of I Revised 6/13/2006 -CH
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