HomeMy WebLinkAboutAPPLICATION - 05-00307 - 4268 S 5500 W - Gas Line08/25/2005 11:59 2086243774
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$UILDINC3 PERMIT APPLICATION
l9 E MAIN, REXBURG, II). 83440
205-359-3020 X322
HOUSLEY PUMPS INC PAGE 02
Na.1l;6G P.
PERMIT #
Please complete the entire Appiication!
If the questioa dose Aot apply 811 in NA for icon applicaDk
PARCEL NUMBER: (We w-ll provide this for yoa)
SliHD1VTSION: UNITii BLOCK# LOT#
(Addressing i9 baetsd on the information • must be actttrato)
CONTACT PHONE #_ 7 rU - f~7 g -1'U~ 5~-
PROPERTY ADDRESS:_„~(~ ~ 5 ~ S SU (I uJ ._~h ~g- ---
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMA1L FAX
APPLI ~V~: (If other than owner) ~ c. ~ S -~ tn~
(_4pplicent if other than ow~ar, a statement authorizing applicant to act as went for at atoll Aeeotttpaa-y
APPLICANT 1NFORMATIUN: ADDRESS CITY
STATE; ZIP EMAlL FAX
PNONF #° Horne ( ) Work ( ) Ccll ( )
IvlAl1,ING ADDRESS: . (~ l.c.J~S~- VYl a i vt CITY STATE~_ZIP. 3 ~
PHONE: Homc# Work# L~a~-~~7a Cell# - 3 7~ CTh~n~~
ElvtA1l. FAX (oa ~F - 3 ~? ~-
How many buildings arc located on this
Did you ttxendy purchase this property? No Yes (lf yes give owner's name)
is this a lot split? NO YES (Plea bring copy of new legal description of property)
PROPOSED USE: S ~ L c ~
(i.o., Side Family Reaidetltce, M ti Family, Ape
Garage, Commercial, Additlom.
AP PLICANT' S SIGNATURE, CERTIFICATION AA1D AUTHORIZATION: undor penaley al pev~r, ! herby o~tily chi t
tow xesd ~b+s epyGatioe and state that the iaforttseaia~+ Sarin it cettsct And i serer that yly lnlprlaat1011 w!ttc~ tray Aactftct be ~vm by ttm In hw~lter bakoro ttee
Plarmine and Zoa4tZ Commiasien err the City Catm~ail fot dtc City of Racbwtl shall be trutltfvl sad ootraot. I sea to oomDly wiUl ell Cily ~aoultttlOtM ert0 Stilts laws
nlatfng ro the ssttject matte! o[dda gipflostlon and hereby authotitAl royt'eaantativos of the Ciq~ to enter ~ot+ the a0w~a-n-entioatad p~vpar4i fos inapeOdonl t~~
NOTE; 'lbe bulldin` offivid may !evoke a pmt as approval issued wider the pro.•isiotts of ta,p 2000 Iaternatitmel Code m cases or srt7 false stasaaaa aQ
roixroyraf~entati0n Vf io the appllcavon or oe ~ plans as which the ptrmn or spprwal ays timed. '[brmn !veld if na stated althln ] 80 days. Peettrit void if..odc
Mops IeM I BO
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~MM ~~~5.'. CDs''
ni--`"-- -err .--/A~~l:..•..• DA`h
Do you prefer to be eontactt:d by fex, cnir~~r PhDs!:? Circlt One
wASrtnvo - 8unv~ rIICRMI'f A1i1ei7C ~ t09T[~- ox corlslr>etvcrwN srre!
Plea lea an oaa-rafiade6la sad sh pakl is !aU rK the theta of Bp~ge#t1ea11t+e~IttolOt ~~
CNy ellltaaAarg'B Aaet-ptaaoe of t)a plea rtevlaw tea doa Dot coaatihts pUa atppraval
08/25/2005 11:59 2086243774
Please complete the e>u~e Application!
applfcnAle
NAME
PROPERTY ADDRESS
SUBDIVISION _ _.__
PAGE
U tho gaesfion doeo ~pptr !ill in NA for non
Permit
03
Required!!!
MECHANICAL
?Mechanical Contractor's Name~~chue~l r~ s/ Bn~n~' Nee= ~i".~.~~ ~1~---r-S r~~+~-
- - ~, L'~- ---
Address '-~ U [,,~Jc c+- I/Yi !~i n City Stater~~____! - .rZip,_~3 ~~~
Contact Phone: (~10~5) (n ~c.l - 3 '7 "Ia. Business Phone: ~) ~o a N- ~ 7 ?d~
);mail Fax a~lJ fr - !~ a ~l_-_ ~ 7 ? ~/
1Vi®ehaniieal E'timate S (CommereiaVMurii Fmmifiy Ott)
1 aTA'T'URES ~ APPL~IA.NCES COUNT (Single Fa~dly Dwellurg O-Jy1
Air Conditioner Space lieates
Bath Fan Vents
Range Hood vents
Boiler
Cvok 5wve Vents
Decot~-tive Gas Firepl®cea
Dryer Vents
Evaporative Cooler
Exhaust or vast ducts
X Fuel (bas) piping fixtures or appliance outlets
Fonseca
Fumaca/Air Conditioner Cvmbo
_ ,,,~ Heat Pump
Inciberator
Pool Heater
Heat (Circle a]I that apply) Gas Oil Cva] Fireplace Electric
unit Heater
Mechanical Sizing Calculations mast be submitted with Plana d~ Application
int of Delivery must be shown on plans.
~l ~k. -C ~ I l ~[o ~ _cl ~ -
Signature bf L3c s Conerae r Llcenso nwn~ea' ~~
Required!
The City JJ'Rezburg ~ permit fem s~he~le is the same ar regatted the State o~'ltlaho