HomeMy WebLinkAboutBP & APPLICATION - 05-00275 - 2105 Ferris Ln - MechanicalZ
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City of Rexburg/ Madiso~ounty PERMIT #
BUILDING PERMIT APPLICATION Please complete the entire 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:~Q pS ~ ~~, Obi CQ2D (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: ~ I~~ I"-c~~ft~s L c2 n ~.
PHONE #: Home (t~ -~~-~, Work
Cell
OWNER MAILING ADDRESS: CITY: ~ STATE:~ZIP: ~~11'YC?
EMAIL FAX
APPLICANT: (If other than owner) ~~,.,, Qa y~vi~.~~, t,.~'" ,.,i/~r~
(Applicant if other than owner, a statement authorizing applicant to ac as agent for owner must company t a ication.
APPLICANT INFORMATION: ADDRESS ~~ ~ /~ /`~U'U ~ CITY:S~ ~r ~~
STATE; .~c~ ZIP :~'~'yri EMAIL ~ FAX
PHONE #: Home ( ) G .~ y ys~ Work
Cell ( ) 3j3 ys~~
CONTRACTOR:
FAX
MAILING ADDRESS: ~~ 3 ,Z/' /'~fc~ ~ CITY ~i'"`/~-- STATE..,,( ZIP X35%
PHONE: Home# ~ ~Y tf 52~7~ Work#
EMAIL
~>c•yt
Cell# 3%,3 y ~{ ~ ~i'
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of penury, 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 the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work
stops for 180 days~~ ~„
Signature t~wner/Applicant
~1f3 /1~~
DATE
Do you prefer to be contacted 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 Rexburg's Acceptance of the plan review fee does not constitute plan approval.
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Please complete the enti~ Application! If the question doe~t apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required!!! MECHANICAL
Mechanical Contractor's Name: Business Name:
Address
Contact Phone: ( )
Email
State
Zip
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
r 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
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor License number
Required!
City
Business Phone:
Fax
Date
~I The City of Rexburg's permit fee schedule is the same as required by the State of Idaho II
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