HomeMy WebLinkAbout4436 VISTA DR - APPLICATIONS - 5/17/2017Planning, Development and Transportation
City Of Building services Department
Fort Collins Fort Coll ns, CO 80524 O Box 580
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 # J✓ I :10 � l�
For office use only
Date 5/17/17
Job Site Address (required)
Value of Construction (labor, materials, profit)
4436 Vista Dr Fort Collins Co 80526 31,668 00
Property Owner Name
Address City/State Zip
Phone
Elizabeth Delap
4436 Vista Dr Fort Collins Co 80526
570-419-6251
Applicant Name
Address City/State Zip
Phone
Becky Pack
24619 Washington Ave #201 Murrieta Ca 92562
800-980-9835EXT4
Solar Contractor License #/Co. Name
Address City/State Zip
Phone
New Power Inc
24619 Washington Ave #201 Murrieta Ca 92562
951-319-3555
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
❑ Here ❑ Report
Sales tax number is required by allmnbaclors
Are you paying with your trust account?
❑ Yes 49No
IF SOLAR PV SYSTEM, HAS THE PROJECT BEEN PRE -APPROVED BY CITY LIGHT AND POWER? ❑ Yes WNo
Is this a residential or commercial project? ❑ Residential ❑ Commercial
If residential, is it 4WSingle 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 morel ❑ Yes WNO If yes, you may need to contacYFbstonc Preservabon
Description of work*
Residential Solar Installation, ystem size 8 12, 28 Panels and Micro -inverters
*Please note in description if, roof Flush mounted, roof mounted & elevated, ground array, kw amount, how many solar panels
subcontractors: List the company name or Gty of Ft Collins license # (PV MUST fist Gty Registered Elect7oan — Thermal MUST
fist City Registered Plumber)
ElectnaarMiracle Electric Plumber Roofer (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:
Print Name Becky Pack Signature Date 5/17/17