HomeMy WebLinkAboutAPPLICATIONS - 05-00322 - 1277 Red Cedar Rd - New SFR MechanicalZ
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C'~~~'Y 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: (~ t1ri'~r. ''~-at'ra ~ CONTACT PHONE #
PROPERTY ADDRESS: /o`I ' % %~' ~ ~`
PHONE #: Home (,c~)
Work (~~ )
Cell
OWNER MAILING ADDRESS: /2 7 ") ~-~?C:;1~..~ CITY: ~ STATE~~ZIP: g~~o
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
PHONE #: Home
Work
Cell
FAX
CONTRACTOR: ~C.-t.~ ~ p
MAILING ADDRESS. ~ ~,5-~ E L/~a //. CITY ~ C~ STATI~ZIP g35`~
PHONE: Home# G`~ ~/-~"`~y`%' Work# L~ ~ ~/-l y~.f' Cell# '~ '"-~ 6~ y
EMAIL
FAX ~~ ~/-~ ~~/
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 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 pennit or approval was based. Permit void if not started within 180 days. Permit void if work
stops for 180 days. ~ _ -
c~ / ~ ~` /
Signature of Owner/Applicant V 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 Regburg's Acceptance of the plan review fee does not constitute plan approval
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P~`e~se complete the ent* Application! If the question ao~t apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! M~~H NICAL
Mechanical Contractor's Name: U"1SGa ~~i'T//~C Business Name:
Address ~ `f ~ ~ S`~'~ ."~ City ~r~~ State ~~, Zipg~~S
Contact Phone: (~~) 3/,.3~ ~>~ 5/~ Business Phone: (jti~) -G'-~ ~ -~ ~`~ 6 ~
Email
Fax f -~ y - ~ y~"1
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Air Conditioner
Bath Fan Vents
Range Hood Vents
Boiler
Cook Stove Vents
-~~ ecorative Gas Fireplaces
~t/ D er Vents
ry
Evaporative Cooler
3,~ xhaust or vent ducts
~ / Fuel as i in fixtures or a liance outlets
_„~ // (g ) p p g pp
~_/Furnace
Furnace/Air Conditioner Combo
Heat Pump
Incinerator
Pool Heater
Space Heater
Unit Heater
Heat (Circle all that apply) Gas it Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Lice ed Contractor License number Date
Required!
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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