HomeMy WebLinkAboutVACATION HOME LIFE SAFETY SURVEY 225 Cyteworth Rd 2017-12-19Office
Received Date
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Town of Estes Park Permit Number V11LSP1247
Received By )t Vacation Home Life Safety Survey Application Expiresl 48 18
Department of Building Safety 170 MacGregor Avenue P.O.Box 1200 Estes Park,CO 80517 ——
Information (970)577-3726 *Inspection Line (970)577-3721 *FAX (970)586-0249 *.v.n.esIesg Permit Expires
______________
Job Address:QwacUl a #of Bedrooms
Owner Name:Lch Phone:33t z’H 2039
Address:k7v1 GOVC1av\ft.AL.R \%-2 2
(Street)(City7’I (State)(Zip Code)
Applicant:Qcg&co3o\‘eoi*y Town License #:636 Phone:S70 ..5t€s 6S
Address:(7t /1/L-cL\.e Avc ta1 ‘?-
(Street)(City)(State)(Zip Code)
Description of Work:LIFE SAFETY SURVEY
I certify this application is tme,correct and will comply with local o[dinanc.es,state and federal laws as well as building codes.I certify that I have the property owers
authority and permission 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 codes.
Siature —_Date Print Name —
***Office Use Only ***
Vacation Home:_________________Large Vacation Home:9 Permit Fee:$200.00
Zone District County Tax:$0.005ciDateBu5Jding
/2—i-c Total:$200.00
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DEC20 2017
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