HomeMy WebLinkAbout804 BROOKEDGE DR - APPLICATIONS - 7/25/2019FCity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
- 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ WoodlPellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # ' &� %66 Date 7/25/19
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
804 Brookedge Drive Ft Collins 6200
Property Owner Name Address City/State rp 80525 Phone
Stephen Ogle 804 Brookedge Drive Ft Collins 970-482-1482
Applicant Name Address City/State Zip Phone
Contractor Address City/State Zip Phone
On Target Roofing 5210 Coral Burst Cir, Loveland CO 80538 970-619-8902
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? RI Here ❑ Report
Sales lax number is required by allcon&actors Are you paying with your trust account? Lot Yes ❑ No
Is this a residential or commercial project? 2 Residential ❑ Commercial
If residential, is it: m Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building So years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 1 story - 31 cnr cares - tear off and install to code - class 4 shingle Malarkey Legacy
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List Me company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Red Canyon Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until It has been paid and issued.
Applicant,alex millsap 7l25/19
Print Name: alex millsap Signature Date
Revision date 2/b2M7