HomeMy WebLinkAboutAPPLICATION - 05-00414 - Just Sports - Mechanical~'ITY'OF REXB URG
BUILDING PERMIT APPLICAI~6~
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
PERMIT #
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Please complete the ent><re Appl><cat><on!
If the question does not apply fill in NA for non applicable
0~ 00414
sUBDIV1sloN: Jusl Sports -Unit Heater Installation _
(Addressing is based on the information -must be accu~
NAME: C; t .~ r, ~ ,
FAX
PROPERTY ADDRESS: 1 I Sy S~c~i Arc
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS:
EMAIL
CONTACT PHONE #
CITY:
STATE: ZIP:
APPLICANT (If other than owner) 6Ze ~„- -~v n e~
(Applicant if other than owner, a statement authorizing applicant to act as
APPLICANT INFORMATION: ADDRESS
STATE;
owner must accompany this application.)
CITY:
ZIP EMAIL
PHONE #: Home ( ) Work ( )
Cell
FAX
CONTRACTOR: ~ e ~}a y~ex'~- P~
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
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
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial,
tJ
~ C T 2 7 2005
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 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. 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
permit or o al was based. it void if not st ed within 180 days. Permit void if work stops for 180 days.
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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 Rezburg'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**
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r~ease comp
applicable
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NAME
PROPERTY ADDRESS ~CS~ .S-~K ~.
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~~~ e ~~.~,,.,,~,~~`~ Business Name: Sp~,h~.- N~~~ ~~„
Address / 5~ /1/ yU /~0 /= , City R ~ ~y State T~ Zip~~
Contact Phone: (zv~) 3, 3 ~- 3~ lS Business Phone: ( ) Su,,..~
Email
Fax
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r .aa -w!.+riae.YR.ew~wM~
. If the question doe of apply fill in NA for non
Mechanical Estimate $ ~rvv u~ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES 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) Gas 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.
~--~~~ 2 ~ l r o a~-v
y ~
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