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Home My WebLink AboutAPPLICATION - 05-00306 - 234 Cornell Ave - Mechanical/PlumbingCITY OF REXB URG 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: (We will provide this for you) SUBDIVISION: UNIT# BLOCK#~LOT# ~, (Addressing is based on the information -must be accurate) OWNER: ~,,~~a~7 ~ ~ ~,~',~ ~~~ ~ ~., CONTACT PHONE # ~:~% ?~ ~ . ~ ~/ -_~ PROPERTY ADDRESS: -~_3 ~ ~'~ <' ~ "` ,~'~~ ~~t~ ~ ~tr;~f L,r~c~Sa~.~ ~ 1)~~.L'~. PHONE #: Home (~'~'~~ ~ ~ - ~ ~~! l~, ~ Work ~~C) ~~~'~ -_~/.~ ~3 Cell (~~ f~'~'x' - ~"%~ OWNER MAILING ADDRESS: 'f ~%!~ Fi'~i~l fi NF ~~CITY: ~" ~ _,i c~~STATE:ZIP: lX ~ C EMAIL~r~/~C~~t~~C. ~ Cctl1i'%tlS~iGr~~ ~r,--. 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 STATE; ZIP EMAIL PHONE #: Home Work Cell ( ) How many buildings are located on this property? ~~~-ti Did you recently purchase this property? No Yes (If yes give owner's name) y~~ f ~nn+ ~ ~ ~7 f~ r"7LZ ~1 ~~~~ ~"- Is this_a lot split?~NO , YES (Please bring copy of new legal description of property) PROPOSED USE: r~ f~~7" ~~{~.,~~ (i.e., Single Family Residence, Multi Family, Apartments, 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 sweaz 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 pernxit~approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. _ ~~' Signature of Owner/Applicant 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 **Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear** CITY: FAX Please com lete the entire A lication! P pP If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION Dwelling Units: SETBACKS FRONT SIDE SIDE Remodeling Your Building/Home (need Estimate) $ Permit# SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area Second floor/loft area Third floor/loft area Shed or Barn Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above g )Area Water Meter Count: BACK Water Meter Size: Required!!! PLUMBING Plumbing Contractor's Name: :S~l ~~r~-~~- Business Name: ~rTJt~t ,;'~ Address /y3 JG~ /~, //S~ City Z !r State =oQ_ Zip_~~3yoi Contact Phone: (aog) S"~g-;moo ~ ~ Business Phone: ( ) , jA ~ Email FIXTURE COUNT (including roughed fixtures) Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa ~_ Sinks (Lavatories, kitchens, bar, mop) Plum ing stimate $ (Commercial Only) Sprinklers Tub/Showers Toilet/Urinal Water Heater Water Softener Signature of Licensed Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho Parcel Acres: Fax Please complete the entire ~plicatlonl If the question does no~ply fill in NA for non applicable NAME PROPERTY ADDRESS Permit# SUBDIVISION Required!!! MECHANICAL Mechanical Contractor's Name: Vlile~,/~s ~yc~T2 ~ ~- t^+~ Business Name: Address 10(3 mar V ~c-w • ~' "''J Uu ~ity~ ~-~~-'e~,.u,e Gc State 1 o Zip ~s~Q~ ', Contact Phone: ( ) ~S~ ~-Y c ~, Business Phone: ( ) Email Fax Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas-fired appliance Incinerator System Boiler Pool Heater Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents ~{ ~ V~nr' other similar vents & ducts: 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 hA~~~2s ~~~~Point~o`f Delivery must be shown on plans. Signature of Licensed Contractor License number Date Required! The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 5