HomeMy WebLinkAboutAPPLICATION - 05-00258 - Ramirez Mexican Restaurant - Mechanical°-J-~' OF REXB UR PERMI
BUILDING PERMIT APP ICATION Please com le~ the entir ~ ~ i
p e Application.
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208-359-3020 X322
PARCEL NUMBER:
( We will provide this for you)
SUBDIVISION: UNIT# BLOCK#_
(Addressing is based on the information -must be accurate)
LOT#
OWNER: ~, ~s~ ~~ ~~ L 12s~,C ,_-CONTACT PHONE #
PROPERTY ADDRESS:_~~- i,~„ ,.~ ~,,~ ~
PHONE #: Home ( ) N /!~" Work
OWNER MAILING ADDRESS:
EMAIL
FAX
STATE: ZIP:
APPLICANT: (If other than owner) ~~~ ~¢S
( pp
A hcant if other than owner, a statement authonzmg applicant to actas agent for o e must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home
Work
CONTRACTOR:
CITY:
FAX
Cell ( )_
~.~ ~-G~
MAILING ADDRESS:! 3 ~ ~ i~o u, CITY ~-~~~A~_STATE .~n_ ZIP~~~
PHONE: Home# - ~ Work# 3 9 ,a ~ ~,a Cell# ~ 3g~a ~ y~
EMAIL ~J /~ FAX_~ ~-~q - oop ~,
How many buildings are located on this property? /
Did you recently purchase this property?Yes (If yes give owner's name)
Is this. a lot split? ~ YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence,
Apartments, Remodel, Garage,
Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of perjury, I hereby certify that I
have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in hearings before the
Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws
relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes.
NOTE: The building official may revoke a permit on approval issued under the provisions of the 2000 International Code in cases of any false statement or
misrepresentation of fact in the application or on plans on which the permit or approval was based. Permit void if not started within 180 days. Pennit void if work
stops for 180 days.
Signature
Do you
p is t ~~~-~~-~-~-
DATE
to ontacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January 1, 2005.
City of Rezburg's Acceptance of the plan review fee does not constitute plan approval
Cell
CITY:
3
complete the~tire AppllCatlOn~ If the questi~oes not apply sll in NA for non
ERTY ADDRESS
IVISION
Required!!!
MECHANICAL
Permit#
Mechanical Contractor's Name: ~~_~ o,,,,,.~ s Business Name: ~~,,,~,~ ,~,~,,,,,, ~~,~„~ ~,,,,,,c„~c ~.~~.
Address ~~~~„~ City ~.~. State S.~ Zip o~~
Contact Phone: (a,~) 33 S- a.3 YS Business Phone:
Email
Fax ~~- S ~ s vaf g~
Mechanical Estimate $ a~-vo ~( ommercia ulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo ~c~,(a,,.~.,,,,,r,.-~
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI '
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
l i a e of Licensed Contractor
Required!
License number
The City of Rexburg's permit fee schedule is the same as
G~ -moo -05
Date
the State ofldaho
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