HomeMy WebLinkAbout4306 BLACK HAWK CIR - APPLICATIONS - 6/25/2019Planning, Development and Transportation
City Of Building Services Department
281 N. College Ave P.O. Box 580
Flirt Collins Fort Collins, CO 80524 2
Phone 970-416-2740 Fax 224-6134 I O J
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 #,
For ollice use ony
Date
Job Site Address (requireo)
Value of Construction (labor, materials, profit)
4306 Black Hawk Dr, Fort Collins,
CO 80526
$17,000
Property Owner Name
Address
City/State Zip
Phone
Rebecca Parish
4306 Black Hawk Dr
Fort Collins CO 80526
Applicant Name
Address
City/State ZIP
Phone
Sandbox Solar
430 N. College Ave
Fort Collins, CO 80524
970-673-7733
Solar Contractor License #/Co. Name
Address
City/State Zip
Phone
S-3665
430 N. College Ave
Fort Collins, CO 80524
970-673-7733
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report?
IX Here ❑ Report
Sales tax number is required tyall contiactors.
Are you paying with your trust account?
❑ Yes I.R No
27948818-0000
IF SOLAR PV SYSTEM, HAS THE PROJECT BEEN PRE -APPROVED BY CITY LIGHT AND POWER? ❑ Yes ❑ No
Is this a residential or commercial project? IR Residential ❑ 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 X No lfyes, you m6y need to contact Hlstorlc Preservation
Description of work* 3kW Rooftop Grid -tide flush mounted PV system
"Please note in description if; roof flush mounted, roof mounted & elevated, ground array, kw amount, how many solar panels.
Subcontractors: Ust the compary name or City of Ft CoNns license # (PVMUST list City Registered Electrician - 7hermal MUST
list City Registered Plumber)
Electrician Alto Electrician 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: Ian Skor `Y awl 6/4/19
Print Name: Signature Date