HomeMy WebLinkAboutBP & APPLICATION - 05-00276 - 503 Laurel St - MechanicalZ
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• ' CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PERMIT #
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK#
(Addressing is based on the information -must be accurate)
LOT#
OWNER: ~~k.r~
PROPERTY ADDRESS: .~O
CONTACT PHONE # 3qp- 3~qy
PHONE #: Home (t, g) 340 -349 y Work ( ) ,~90 - ~~/ Cell ( ) ,~} St/
OWNER MAILING ADDRESS: so3,C~u,~ f,~L CITY: STATE:,~ZIPS~'~~/
EMAIL FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? ~~ e,
Did you recently purchase this property? ITT Yes (If yes give owner's name)
Is this a lot split? C.~
PROPOSED USE: ~~
(i.e., Single Family Residence
YES (Please bring copy of new legal description of property)
lti Family,
Remodel, Garage, Commercial, 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 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.
~ l S'' l zoos-
Signature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email phone. Circle One
WARNING -BUILDING PERMI UST 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
**Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
. Please complete the enti~Application! If the question doe~t apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required!!!
Mechanical Contractor's Name:
Address
Contact Phone: ( )
Email
MECHANICAL
City
Business Phone:
Fax
Zip
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
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
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor License number
Required!
The City of Rexburg's permit fee schedule is the same as
Date
the State of Idaho
Business Name:
State
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