HomeMy WebLinkAboutAPPLICATION - 05-00356 - 2192 E Hwy 33 - Mechanical?0-2005 10:59 AM LEISURE
~e~.20, 2005 10~31AM
523 4638
• No, 1134 P. ~
C~Z'I' OF RF.XB URG PIT # ,w,,,,~
~ ..~1•IO~Mrt,.M~WI~i~ ~M-Y~I.YI-lMM'V~^~MM-1Vw^-~NV.aslr
BvILDIrtG PERMIT APPLICATION Please complete the entire Application
l9 E MAIN. REXBURG, ID, 83440 If tht+ question does not apply tall in NA for taon applicable
208-3~9-3020 X322
PARCEL NUMBER: (We will provide ttrt~ for you)
$1JBANISION: L1NIT# BLG-CK# LOT#
{AddressimS is be~ed tm tha lyatbzn~ation - must be a+acurate)
CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #; Howe ~ ,~~ - `]~3Wcrk ( ) Cell ( )
OWNER lvlAILING ADDRESS: ~ ITY• STATESj,~ZTP: g ~~~
EMAIL FAX
APPLICANT (If other than owner)
(Appllceuct if otter than ovmer, a statetnemt authorizing tt~ppliGmat ip act as agent far owner molt ecco-t;npetty dais application,)
APPi,ICANi' INFORMATION: ADDRESS CITY:
STATE; ZIP Ems- FAX
PHONI? #: Home ( ) Work ( ) Cell ( )
~orvr•~,c~ox:
MAILING ADDRESS: CITY STATE~_ZIP& d
PHONE:""Hon~e#. ~ .-„_ Warlt~ Cell#-
EMAILL~I~J~.CR~~~- n,~r' FAX1~~~
How many buildings are
on this 1~1~Y?.
Did you r~endy purchase; this ~operty? No Yes (If y~ give owner's name)
Is this a lot split? NO„ YBS (Pleose bung copy o£ new legal description of propt~ly)
PROPOSED USE:
(i,e., Singlo Family Re
Aptukttaptq, Reeoddel, t3aeago, Commercial, Addition, 8to.)
APPLICANT' S SIQNAT[]ItE, CERTIFICATION AND AL>THOltIZATION: un6ef penalty of perj~y, I hereby certi$~
that I have read t11i9 0pplfcatiom and stets that ebe Infbmtatlot- herein le cori'Cet end I swear that atty bnfotmation which ~y botet<tber $e given by me
la hearings before tha Pleaming and 2oQdug Cotcuaiaeioa or the City Counc[l fbr the Clty of Rcxb~ug shall bo trvtTd4t1 road eorreat. I agtce to eotnply
with all City ReHuLofeeie sad State law~a relaleg to the sub,~cct matter of thll appliaatlon attd hereby euthorixed npt+cseetaavea of the Clty to enter
upon the above-m®ndoned property thr inspections pwpulom. NOTE: The building a~elal tnay ra~-oke a patrnlt on approval ieaead vader the
provisions oaf the 2000 International Cade !n cases aSatry Eglso statement Or tttlarepreeetttatlon of that in We applicadoa or on the plena on w>?ioh the
pCrmtt or approval was based. Permit void if not started wlthizs ! BO days. Permit void !f works st~opa ibr 180 deyp,
/ ~
Sigatttturo of Owner%Applicent DATE
Do you prefer to be contacted by fax, email or phone? Circle One
w~va - BUII.DIlrG rl~>R.Nn'r 1~tl~r B~ >a oIV G4~1S'FRTJt~'TJDOAi ~!
Plan fees are non-»IpAdable asd ere paid fa still at t8e Um®a(' oppHcatloe begtenlsp ~y~p,
Ciq of 1;t~b.rg'e Aera~ana of Ire plan rwlew !ee does ant csnrtitub pipe ppprovel
•"AnllBtt~ Pareeit Rose aro due et time of appllcatlen+' •+Bolidin~ Permits an volA It yeu eAeek does net cieeria
SEP-20-2005 11:00 AM LEISURE TIME IDAHO FALLS 208 523 4638 P. 04
Sep. 10. 2 Q05 10: ? )AN- , • No~ 1134 P. 4
1 xceial~ vllW~J1000 buG 6u~i~ i 4"'~j~~ruf;.eaix'V'~~ u iua yaue~uvu uuw r~ui uyNQ iii iu, ar v~ n u
applicable
NAME
PROPERTY AD ESS ~ ~~ Perinit~
SUBDMSION _ ,,.
.Requiredlll
M,E~hTANI~CAL
Mechanics! Cantxactor's Namo: L-P„~~S'1.e.1'C~i~.[_. ~/1 C_ , Busine®®Natne: ,~:~,..~,.1 x l
Addres G`~t rte. ~~'~ a 1~~i 1 ~ State Zip 3 i-I, ~
Comact Phone: ( ) Business _Phonc: {~Q~') ..
C ~ S ut L (4~ S~.Y . /'1 _C~ ___ _----- - r a~c~~ ]~<) ~~ cam- ;> -
Mcehanical lgattimate $ (CommerdaUMulti FamDY Only)
FIX~TR~E.S ~ APPLIANCES CO~lNT (5'f~tgle Family lln-rlldn~ Only)
F~nacc Exhaust or Vet Ducts
~~. - -
Furneoo/Air Co~nditior,er Combo
Heat Fturip
Air Cot~ditiaaer
Evaporative Cooler
_,,;~nit cioater
Space Heater
. _......._ ................... Decorative ga®-feed applian.~e
Iucincretor System
Boil®r
Pool Y-leater
Similar fixtures or Appli~uto~-
~~ F~.~rl Cte~p pipe, t3utlt~tts Including stubbed is yr fixture outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that appl Gas 'l Coat Fireplace Electric
oth®x similar vents ~ duets:
Mechanieo191zing ~alcnlations must be submitted with Plana ~ AQplication
___ Point of riellv~ry must be shown on planr.
au~ture o(Lioansed
? he
pryer Vents
Rage Food Vents
Cook Stove Vents
Bath Fan Vents
G - g
Licease nurnbcr
ackea~ele rs si,e sar»~e a,9
tlre,.,"to~~