HomeMy WebLinkAboutPERMIT 1250 Country Club Dr Gasline & Furnace 2000-09-01TOWN OF ESTES PARK
MISCELLANEOUS PERMIT
970-586-5331,ext.3402 or ext.3408
(For small plumbing,mechanical,rooting jobs not requiring plans)
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Valuation of Work:$)916 —
I hereby acknowledge that I have read this
Application and state that the above is correct and
agree to comply with all Town Ordinances and
State Laws,regulating building construction and
zoning.
The Building Department will make every effort to
prevent errors in your Application and Pennit,but
cannot be responsible for your failure to comply
with all Building,Zoning and other applicable
Codes.
______
Revised:August 31,1998
Date
Building\forms\misc_por.wpd
JOB STREET ADDRESS:Date(oc J-it 3j L
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LEGAL DESCRIPTION:
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PARCELID#:53j’-fQ7Oczt
OWNER NAME:tDAjAo?4 1JI’W&N
OWNER MAILING ADDRESS:\45 p.(a-e*t.
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Town State Zipo3——SC,17
OWNER TELEPHONE #:(‘17°)77-rs 99
CONTRACTOR NAME:
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TOWN BUSINESS LICENSE #:2°t°
CONTRACTOR MAILING ADDRESS:cc-A (<3t
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Town State Zip
FOR OFFICE USE ONLY
Type of Construction:
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Occupancy Group
A,B,E,F,H,I,M®S,U
Division
1,2,2J,G)4,5,6,7
Census Bureau #:-S 3 4
Valuation of Work:
_____________________
Building Pennit Fee:
Larimer County Tax:
TOTAL FEES DUE:
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CONTRACTOR PHONE #:(‘flo)-gM5
DESCRIPTION OF WORK:
CLASS OF WORK:
ALTERATION V
REPAIR
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Building Official Signature Date
ermittee Signature