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Home My WebLink About123 N Mack St - Applications/Addition or Alteration - 05/25/2010City of I IlCOMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES For t Colins 281 N College Ave Fort Collins CO 80524 Phone 970-416 2740 / www fegov eom/budding BUILDING PERMIT APPLICATION APPLICATION NUMBER rT APPLICATION DATE__. _.��J_ �h Job Site Address 123 N Mack Unit # PROPERTY OWNER INFO (All owner informat o s squired — it is not optional) Phone # 970 217 2993 Last name Horak First Name Gerry Middle Street Address 123 N Mack City Fort Collins State CO Zip 80526 CONTRACTOR INFO Company Name Bella Energy Contractor Phone # 303 665 2100 Lic Holder Name Geoffery Vezzetti City of Fort Collins License # ME 1121 Supervisor Cert # Mailing Address 500 S Arthur Ave Suite 400 city Louisville State CO Zip 80027 LEGAL INFO Subdivision/PUD Filing # Lot # Block # Lot Sq Ft CONSTRUCTION INFO, Total Building Sq Ft ( t d d e ba m t) Total Garage Sq Ft Residential Sq Ft Comm I Sq Ft # of Stones Bldg Height # Dwelling Units Floor Sq Ft Finished Bsmt Sq Ft 2nd Floor Sq Ft 3 Floor Sq Ft Unf fished Bsmt Sq Ft # of Bedrooms # of Full Baths / Baths / Baths # of Fireplaces Air conditioning YeGo0 Energy info ( Circle appropr ate cho ce ) 1 ComCheck ❑ 2 ResCheck w/Air Sealing ❑ 3 ResCheck w/Blower Door ❑4 Simulated Performance Alternative❑ 5 Prescriptive w/Air Sealing ❑ 6 Prescriptive w/ Blower Door City of Fort Collins Stock Plan # List appropriate option UTILITIES INFO Water Tap Size Sewer Tap Size Metered Yes ❑Nol:l Temp Pedestal Yes❑ No ❑ Type of Heat ❑ Gas F]Electnc Electric Main Breaker Size (Residential only) ❑150 Amp or Less ❑ 200 Amp Other Value of Construction (including labor material & profit) $ 17200 Description of Work Installation of a 3 15KW gnd tied flush roof mounted photovoltaic solar system Contact Name & Phone # of JOBSITE SUPERVISOR Colin Wann 303 665 2100 Subcontractor Info Electrical Framer Roofing Mechanical Concrete Plumbing Fireplace Solar Other Other Other Appl cant I hereby acknowledge that I have read ication and state that the abo a nformation is correct and agree to comply with all requirements contained here n and City of Fort s ordin s state laws regulat ng building construct on Applicant Signatu Print Name Jason Adams Phone 303 862 2458 lop- Distnbuto White — Office Yellow —Applica t Pink — WWW/Stormwater THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE