To apply for a solar energy rebate, complete this application and submit to:

Marin County Community Development Agency

Attn: Solar Rebate Program
3501 Civic Center Drive, Room 308
Marin County CDA
Alex Hinds, Director San Rafael, CA 94903
Fax: 415.499.7880
3501 Civic Center Drive
Room 308 1) Name of applicant _____________________________________________
San Rafael, CA 94903
2) County of Marin employee department (if applicable) __________________
Contact Person:
Omar Peña
3) Address _____________________________________________________
Phone
415.507.2797
4) City __________________________ 5) State, zip ____________________
Fax
415.499.7880
6) Telephone ( )________________ 7) Email _______________________
Email
opena@co.marin.ca.us
8) How would you prefer to be notified of you solar rebate?

Phone Email

9) Solar Energy System:

Photovoltaic Solar Hot Water Heater Solar Pool Heater

10) System Size: ________ Kilowatt (KW) ________ Square Footage

11) System Purchased On: _________________________(DD/MM/YEAR)

12) What is the address where the item will be installed?

Same as above
_________________________________________________________

13) Type of Building: Residential Non-Residential

14) Are you interested in receiving more information on green building?

Yes!
15) Are you interested in receiving information on the green business program?
Yes!
I certify that the information above is accurate.

______________________________________________ ________________
Applicant Signature Date

PLEASE ATTACH SIGNED BUILDING PERMIT, THE SOLAR

EFFICIENCY CHECKLIST, AND A COPY OF YOUR
PAID INVOICE.