HomeMy WebLinkAboutAPPLICATIONS - 05-00419 - 1144 Red Cedar Rd - New SFR MechanicalCity of Rexburg/ Madis County
BUILDING PERMIT APPLIC~ON Please coI
OS 00419
19 E MAIN, REXBURG, ID. 83440 if the quest
208-359-3020 X322 l l4~ Crescent Dr - M:ad. Co. Mech.
PARCEL NUMBER: (Wt ~~--- r-- - - -
SUBDIVISION: ~h ~ l~ t~ 1 UNIT# BLOCK#~LOT#~_
(Addressing is based on tlde information -must be accurate)
CONTACT PHONE # .~ 0 ~-t73y
PROPERTY ADDRESS: I ~ ~1 y ,~'t°, ;~P kl ~ QY -
PHONE #: Home ( )~~G,1o~ ~d`I is I Work ( ) ?~~j, j ~C~S?~`-~ Cell (~d~) ~~~1 b - a~3~
OWNER MAILING ADDRESS: 1 ~~ ~/ l ~«~I CITY: STATE:~J ZIP:~L
EMAIL
.APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home ( ) Work { )
Cell ( )
CONTRACTOR: ~~,~// ,+y~ns~~.
MAILING ADDRESS: ; 7 Z 5 1" J lj~ ~ CITY~~~~~ STATE~ZIP r~s'~~
PHONE: Home# 3/ 3 - I { ~`~ Work# 3S(~ ~yQ~ Z Cell#
EMAIL
FAX
FAX
How many buildings are located on this
y
Did you recently P hase this property? No Yes yes give owner's name) IZ ~ S S (, ~ C ryi e ~, ~
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: S' ~ R.LS~t
(i.e., Single Family Residence, M 1t ti Family, Apartme ts, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that
have read this application and state that the information herein is correct and I swear that any infomration 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 arty false statement or
misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work
stops f~days.
1 , ~s , ~~ s
Si afore of Owner/Applicant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING - BUII.DING 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 Reaburg's Acceptance of the plan review fee does not constitute plan approval.
FAX
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~ieast~ C()mplete the ere r~,~plicatian! If the question not ap~iiy sill ixx NA fin' non
a~~~~hcablc
NAME ~~ ~e
PROPERTY ADDRESS r Permit#
SUBDIVISION L~~ ~ ~1
Required!!! MECHANICAL
Mechanical Contractor's Name: ~-~1~ ~ ~ Business Name: 'V`~"~ ~~"`°° ~~i ~~G
jj .. ~~4
Address ~~ ' ~ ' ~l ~®h/ l~ City State l Zip~~~- "f~
Contact Phone: (~$) b~ f ~ m' O tJ[1 ~ Business Phone: QO ) 3 ~ ~ -' ~ 0 ~ z T
Email ~i a /~ r~ ~~rr~~,~ ~~x , Cv~.Fax /UfA-- ~~
Mechanical Estimate $ ~ ~ ~l (CommerciaUMnlti Family Only)
FIXTURES & A.PPLIA.NCES COUNT
Furnace
~ _~~ Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
;7~ Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
(Single Family Dwe~~Only)
Exhaust or Vent Ducts W ~{
~ _~ Dryer Vents
~ Range Hood Vents
II'' // Cook Stove Vents
J~ Bath Fan Vents
other similar vents & ducts:
~ 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
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~ :,~
Signature of Lip°nscd Contractor License number D e
Required!
The City of Rexburg's permit fee schedule is the same as required by the State. of Idaho
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