HomeMy WebLinkAboutAPPLICATION - 05-00436 - 2633 W 3200 S - Gas LineNOV-03-2005 10:32AM FROM-FALL RIVER ELECTRIC 208-652-7825 T-439 P.002/007 F-093
CITY OF RF~~3' URG
BUILDING FPRMIT APPLICATION Please OS 00436
l9 r MAIN, R1rX.BURG, ID. 83440 Yf't11e quc 2633 W 3200 S-Mad Co. Mech.
208-359-3020 X322
FARCIL NUMBER: ~~~~~,?jqL~~( we will provlae nus ioF y~u~
SUBDI`VISiON:_ ,._ UNIT# F3LOCIt# LOT#
(Addressinb is based on the infotma>:ion -must be accurate)
PROPERTY ADDRESS:
CONTACT PHONI~ #
PHONE #: Dome ~.~ 3 S (.~ -~_~ Work ( ) __~i~ Cell ( ) ~,~ ~
OWNER MAILING ADDRESS: /l~- CITY: STATE: ZIP:
EIYiAIL ~ I'AX ~/
APP,Z,ICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agcttt for owner must Accompany this application.)
APPLICANT INFORMATION': ADDRESS CITY;
STATE; ZIF~ FAX
PI~IONE #: IIome ( ) ork ( Cell ( ) __
CONT'Xf1CTOR:
MAILING-ADD SS• P ~ ~3~?r ~p ,,•_ C1TY "~ (. 7Yl STATE ~~ GIP
PFIONE: Home# ~S~'~ns,~ Work# Cell# /~ ~/~
ENIAIL~~f~ FAX. /~
How many buildings are looted on this property?
Did you recently purchase this pt'operry? No Yes (If yes give owner's name)~,~
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROFOSED USE: ~~
(i.e., Single Family Resicirncc, Multi Family,~Aparunrnts, Remodel, Garage,
Addition, Etc.)
APPLICANT'S SIGNATURE, CER'I`IFICATION AND AUTHORIZATION: under ponalty oCperjury, t het'oby Certify that I
hsve read this application snd State that the information heroin is correct and i swear that any in formation which m$y hereatler be gluon by me in hearings bcfot~e iho
Planning and Zoning Crrtnmisgion or rho City Council for the Ciry of Rexburg shall be [ruthfui and correct. I agree to comply wish alI Ciry rogulations and start laws
relating to the 4ublect matter of this applicstion and hzreby uttchorizcd rnprocontatives of the City ro tsnrer upon the above-mon[ioned property for ittspoclions purposes.
N~TF; The building offic is1 miry revoke u prnnir on apprpval ~SSUed under [hc provisions pPthc 20 W International Colo in cases of any false statemcn[ or
misrrpreacnracion pf fact in nc~ application or on rho plans on which the perm;[ pr approval was based. Petmi[ void if not stsrtcd within 1 [i0 days, Pctmi[ void iP work
Mops for 166 days.
_~l~/ I / l
Sig[tttCurr of Owner/Appliestttt ~ llA•rB'"
Do you prefer !o be contacted by fax, email or phone? Circle Qne
WARNING - }3ULLDING I:ERMIT MUST BE POSTCll ON CONSTRUCTrON S1TE!
Plan Pees are non-rafurttfable and are paid in full at the time of application beginninb Jatuavv I. 20AS.
C;ty of IZexbl[rg~s AcccptaLLco of the plan review Pcc flocs not t:unatitutt: plan approval
NOV-03-2005 10:32AM FROM-FALL RIDER ELECTRIC 208-652-7825 T-439 P.003/007
~~C~Se COhlp~@te lf~le entire ~.pIJ~lCatiOri ~ Yf the question does not apply fill In NA, for non
aptrlicabte ~GUY~-r _
NAMI^
pROpERTY ADDRL-SS __~~33 WT 3~u S• ~~~r''`-'~.-- Perrnit#
SUBDIVISION
F-093
.Requi~~d!!! MEC`MA.NICAL ~
_ ,
Mechanical Contrae[or's Nam_~ ~~ Business Name:
Address ~ ~l3Z`n, ~~0 /1 Ciry CIS ~~`;~'~ State t~ .Zip ~3yJ~
Contact Phorte: (~ ~~ - ~ `~ ,~_~ _ Business phone: ( )
>mmail pax
Mechanical Estimate S (Commercial/1Vlulti Family Qnly)
1'%1'XTURES & APP,1:I~1VC,,i~S COUNT' (Single Fa»aily Dwelling Dndy)
Air Conditioner Space Heater
Barh Fan Vents
Range Hood Vents
Boiler
Cook Stove Vents
Decorative Gas Fireplaces
Dryer Vents
Evaporative Cooler
)exhaust or vent ducts
~_ Fuel (gas) piping; f xtures or appliance outlets
purnace
Furnace/Air Conditioner Combo
Heat Pump
Incinerator
Pool Heater
Unit Heater
~ -r~'~- ~
-~-o w~-.mil
~~
r a-~- `~^
h-axe--~
Heat (Circle all that apply) Gas Oil Coal Fireplace Clectric
Mechanical Sizing Calculations must be submitted with Plans & Application
t'oint of Delivery must be shown on plans.
Signature of L.icens • nuactor Licc:use number' Datc
squired! ~ /~jj~~-~ //7~
2'hc Ciry ofRexbr~r~'s permitfec schedude is tfie same fiw rcyuir-ed by the Slare ojldnhu
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