HomeMy WebLinkAbout3626 Cassiopeia Ln - Applications/Solar - 02/24/2014Planning, Development and Transportation
City of Building Services Department
281 N. College Ave P.O. Box 580
Fort Collins Fort Collins, CO 80524
/11*0 �Phone 970-416-2740 Fax 224-6134
SOLAR PERMIT APPLICATION FORM
This application is to be used to apply for the following permits only (check the appropriate box):
Photovoltaic Solar (PV)
❑ Thermal Solar (Hot Water System)
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application #
D1y01Oo8
for office use only
Date 1z Z`1 - Z O 0A
Job Site Address (required)
Value of Co truction (labor, materials, profit)
3(o Z(o (fiiS10 PEIA 646E
T 132, 0_
. is
Property Owner Name Address
)nsH,JA 6
City/State Zip
Yi co
,,Phone.
Lo632
Zg—
',�plicant ame Address
OM ' 10(le5 �lf4rVI5,Lr S6-,4,c �3p
City/State Zip
A-� y . 14 r�- a
Phone
3o3-Y47•agw x.2
Oozes
Solar Contractor License #/Co. Name Address
City/State _ Zip
Phone
S - 207,5" Ar- - SOLAtL VS -I\ 600"—Av 7*. 3w,o4(LL. T0J!,94
. f-5_41f7- 10o 5
Contractor City of Ft. Collins Sales Tax #
Sales tax number is required by all conbactom
Z-0 - 72J6& o S 7
Are you paying taxes here or by report?
Are you paying with your trust account?
® Here ❑ Report
❑ Yes ❑ No
IF SOLAR PV SYSTEM, HAS THE PROJECT BEEN PRE -APPROVED BY CITY LIGHT AND POWER? 19 Yes ❑ No
Is this a residential or commercial project? Ukesidential ❑ Commercial
If residential, is it: `,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 50 years of age or more? ❑ Yes gl4o If yes, you may need to contact Historic Preservation
Description of work*
—I"STALL �, - I'.L� F-0slt I�e+rT� (�.c�n �1e�0 SaL/i✓P �L�
*Please note in descriptlon if; roof flush mounted, roof mounted & elevated, ground array, kw amount, how many solar panels.
Subcontractors: List the company name or City of Ft Collins license # (PV MUST list CIty Registered Electrician - Thermal MUST
Ust City Registered Plumber)
Electrician Plumber Rooter (For solar PV shingles)
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: �� t�
Print Name: I o �t oo e 5 Signature Date Z 2 q • Zo( N
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