HomeMy WebLinkAboutAPPLICATION - 05-00418 - 1162 Crescent Dr - New SFR MechanicalOct~21. 2005 2~36PM
~~'TY QF REXB URG
BlJ1LDING PERMIT APPLICAT~
19 E MAIN, REXBI)R('i, ID. 83440
208-359-3020 X322
No~1099 P. 3
FL;FtMI i #
Please complete the e~ire Application!
if the question does not apply fill in NA for Icon applicable
FARGEL NUMBER: (We will provide this for you)
SUBDIVISION: ,~"~r; > %~.~- ~`~~>~~~'~ ~!~>IC=~~ ~T# BLOCK#~LOT#_,
{Addressing is rased on the inforrnati~n -trust be accurate)
CONTACT PHONE # ~;/ "~ ~r~ %~
PROPERTY ADDRESS:
PHONE #: Hamc (
Wark (
Call (
OWNER MAA.ING ADDRESS: CITY: STATE: ZIP:
EMAIL
FAX
APPLICANT`. (If ether than owner)
(Applicant if other than awns, 8 stattrnetlt authorirnlg applicant to act ac agent ti)r owner mnst accompany this application..)
APPLTCANT INFORMATIONS ADDRESS
S1'A"1')E;L!P EMAIL
PHONE #: Home
Wark
Cell
CONTRACTOR:
MAILING ADDRESS:
FHUNE: Home#
CITY STATI; ZIP
Work# Cell#
EMAIL FAX
How ttlarty buildings are located on this property?
Did you recently purchase this property'? No Ycs {lf yes give owner's Hamc)
Is this a lot split? NO YES (Please bring copy of new legal desCriptian of property)
PROPOSED USE:
(i..e., Single Family Kesickntx, Mtilti Family, Apartments, Rrmodcl, Garage, Commtxcial, Addition, Etr..)
APPLICANT'S SICGNATURE, CERTIFICATION AND AUTHORi7..ATION: tinder paiahy of perjury, t herehy pertify that !
have read ihiR upplitadx'rn and aisle that the irtkmnalxm hucin is c.xrect arat 1 a+vew that any mforw~im which may hereaRw be given by me in hcarirtgs bcforo the
!'fanning amf Zoning Cottanissim or tltc City Coancii for the City of Rexburg shall be uuthfal and correct. I agree to tprt~ty with all City regulations and Stan laws
rdAting to the subject matter of this apptic8ticrn aad hereby atldtalizcd rcpresetttativcs of the Cry to cats ton the about-mcrtioacd property for iropcctioro purposcs-
NOTE: The buiWm~; official may revole a permit am approval issued muter the provisions of tt~e 24001nmmational t:ode is ca-es of any false statement or
misltptescmation at tact in ttu application or ~ tl~ plans on which tiK permit or approval was based- Permit void if t~ started whltin 180 days- Permit void if work
stops for 184 daya_
1 t
Signature of Owner/Applicant BATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING - BU1LDIf~IG PER1MtT 1M8USa' BE ROS'I('1~A OIV CONST'.RUCrION St7'E:
]iHsta ises are atoa-rdiatdtt~e aa~ tae paid i>, fall at the tine of ItppfietNio>, beaieaiaa .7avrrsarv 1.1905.
City of Rabart's Atxeptance of the plea review fee does aot coastitate pla>a approval
CITY-
FAX
3
O~t~21~ 2005 2~36PM
l*lease complete the entil~gplication!
applicable
NAME
PROPERTY ADDRF,SS
SUBDIVISION
No~1099 P~ 4
If the question does not~ly fill in NA for non
Permit#
Requared!!! MECHANl~AL
/ a J,. l /,
Mechanical Contractor's Name- ; ~ .a/'~ A~/ ~f ,e-%% Business Name: f(~ ~~ /~r~ ~~ ~~
-i
Address ,~-c ~!, j~ ~, ~'~~ -fir ~,_' City f'!l n'-~v /~,.~ State Z ~ Zip ?~a~~~ l
Contact Phone; (,2E?~ } ~; ~~ - ~C ~ Business Phone: ( } ~5,~ /'
Email Pax
Mecbanics~l Estimate $ (Commerei$VMaNi Family Only)
FIX~'tl ~ APPLIANCES COUNT (Single Family Dw+eUinB FYI
Air Conditioner
Bath Fan Vents ?,D
Range Hood Vents
Boiler
Conk Stove Vents / ~ D
~ Decorative C7as Fireplaces 3~ ~ 5~
Dryer Vents i ~ ~/(~ ~
Space Heater
Unit Hester
Evaporative Cooler
t Exhaust or vent ducts W , {~ .
:;' ~ Fuel (gas} piping fixtures or appliance oatlets
,~'' Furnace
~~ FurnacelAir Conditioner Combo 3 ~
Heat Pump
Incinerator
Pool Heater
Heat (Circle all thax apply),, ra~~ Oil Coal Fireplace F,lectric
IV)(echsnical Sizing Cak®lstions mast be sabmitted with Plans & Application
`~ ~ Point of Delivery must be shown on plans.
Signature o{' Licensed Contractor License number ate
Required!
The City ~~RexMrrg's permit fee schedule is the same as required lry_the State ofldaho