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Home My WebLink AboutAPPLICATION - 05-00390 - 3855 Mountain View Dr - Mechanical,t 17 05 03:49p p.1 CITY OF REXB URG • PERMIT # BUILDING PERMIT APPLICATION Please complete the entire Application! 19 E MAN, 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) ~ CONTACT PHONE #~ .~$lv- 3~/ ~ ~ PROPERTY ADDRESS: 38'SS ~- lh'fov~~~ U~`~cv IJ~- ,~r~.(,..~ PHONE #: Home ) ~Sl~-3'y3~ Work ( ) Cell ( ) OWNER MAILING ADDRESS: CITY: ~~ ~ ~~ STATE: ~~ZIP: ~~~~o EMAIL FAX APPLICANT (If other than owner) C ~s ~--- ~-~ ~S ~ ~• r~~,~ _~s (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS ~$ ~ S' /YO/~y~~s~s~..~~~~ITY: ~~~~ "'S STATE: ~c~ ZIP ~~'~L/o EMAIL FAX 3 S~- ~ S ~ PHONE #: Home Work (2c~)~S g- ~0.~8' Cell CO?YTRACTOR: C c-s~~ b~-~s' ~~r ~ ~--~'/~Lt :.ter MAILII~TG ADDRESS: ~5g S, ,~//~w~ ~ ~r3/ CITY ~~c ~~~~ STATE L~. ZIP ~f5% PHONE: Home# EMAIL Wark# 355-~~$ Cell# AX 3s1-3~'~~ How many buildings are located on this property? ~ Did you recently purchase this property? No Yes (If yes give owner's name) J~(.U Is this a lot split? NO YES (Please bring copy of new legal description of property) PROPOSED USE: (i.e., Single Family Residence, Mnlti 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 ]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. 1 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 ~ Perrnit void,if~~ed within l80 days. Permit void if work stops for 180 days. Signature of Owner,~App cant BATE 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 JanuarE /. 2005. City of Rexburg's Acceptance of the plan review fee does not constitute plan approval *kBuilding Permit Fees are due at time of application*'~ **Building Permits are void if you check does not clear** Oct 17 05 03:49p p.2 Pjcase complete tae enti~Apphcat><onS If the question doc~t apply fiil in NA for non applicable ! NAME ~ L-~-. ~t-~Ff~~%r~d PROPERTY ADDRESS ; ~''S 5 Lv. h~®vr'r~ w. y;.w~IS;w Permit# SUBDIVISION IUtQ Required!!! Mechanical Contractor's Name: Business Narne: C~~~R..~.-t~s~,rk~.~-~- r~~f Address___ ~u S l 5 ~ y~/!ow r~ ~-l~.y ego t City ~~~~~ State ~"-`- Zip ~3`f~i~ Contact Phone: ( ) Email Business Phone: (~c-g) 3Soi -~ oa S" Fax ~ S L-~ - 35 ~`~ 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 Similar fixtures or Appliances ~_ Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) Ga - .Oil Coal Fireplace Electric Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. . ~~ /~ ~ ~~G~ 10--1~= Os Signature of License ontractor C,icense number Date Required[ The City of Rexburg's perrrrit fee schedule is the same as required by the State of Idaho MECHANICAL 5