HomeMy WebLinkAboutAPPLICATION - 05-00438 - 478 W 3500 N - Gas LineNOV-03-2005 10:33AM FROM-FALL RIDER ELECTRIC 208-652-7825 T-439 P.006/007 F-093
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CITY ~ BURG 45 00438
EUILDING PERMIT A,,PPLICATION' Fle 1.
19 E MAIN, RIrXSURG, ID. 83440 If th 478 W ~ 500 N--Mad. Co..Mech. ale
24$-359-3020 ?322
PARCEL NUMBER:__ ___ (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressizlg is based on thz informatiotl -must be accttratt:)
owNE]t ,NAME': CONTACT pHONi: # ?.~~5- (p, 7~ 7~
FROPIwRTY ADDRESS: 7 ~ ~.l ~ ~
PIIONE #: Nome $O~ 3 alp ~ 7 ~! '~`~7Vork ( ) /~ Ce 1( ) /~
OWNER MAILIN~G/ADDRESS: CIT'Y:^,,,_ /J/f~. STATE:~p: F~
EMAII._ / l/ ~ -FAX
APPLICANT: (If other than owner)
(Applicant if ether than ownrr, a statcmettt authorising applicant to agt as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS ~
STATE;- _- GIP ..,,._ _ L
PfIONE #' Home ( ) ork ( ) Cell
FAX
COIVTRACT011i
MAILING ADD SS: ~ ~ l~a~ _-~~C~ CITY ~sl~'6Vl STATE l ~ LIP ~~L/2(
PHONE: Homt~~~~'b~ X31 Work# Cell#
I:MAII. FAX
How many buildings are located on this property?
Did you 1'eeent:ly purchase this property? No Yes (If yes give owner's name)~1
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: _
(i.e", Single Family Residence,
Family, Apamnents, Remodel, Garage, Gottimercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTPIORIZATION: Under penalty of perjury. I hereby eertifl shat I
have read thi& application and stare tlutt the information herein is correct and 1 swear that any infottllation which may hcroafter be given by tnc in hearings before the
Planning and Zoning Cornmusion or the City Council for the Ciq~ of Rexburg shall be truthful and eotTCCr. f agree to comply with all City regulations and Stale laws
relating [o ihd suklject matter of [his application and hereby authori>ed r2prosentarivcs of tho Ciry to enter upon the above-mentioned propcrry for inspections purposes.
NOTt; "['Ytc building official may revoke a permit nn approval issued under the provisions of the 2000 Inse~tlational Codc in cass¢ of any false statement or
miereprescnration offact in the application or on the plans on which the porittit or approval was basod. i'2rmit void if not stu~red within 180 days. Permit void if work
stops for 180 days.
/ /
Sigttaturc of Owner/Applicant DAT1;~
Do you prt~.fcr to be contacted by fax, email or phone? Circle One
WA1tACxNG - BUiLDINO PERMPT MUST BI= POST FD ON CONSTI2XIC'110N SITE!
Plan fees arc non-refundable artd ere paid in (ul1 ar the time of"application beginniag Januory 1.2005.
City of Rcxburg's Accoptanctr of the plan review fee QOea nut constitute plan approval
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NOV-03-2005 10:33AM FROM-FALL RIVER ELECTRIC 208-652-7825 T-439 P.007/007
Please compYete tll~e e>r~#l~-e ApPlaen#ion! Yt'tl~e question does not apply ill in KAY for non
applicable
NAME s~~.c.-2 Vl.~~~a~--
YROPERTY ADDRESS _ ~f l c.V ~ Sy ~ n • r~Qi hw~-• Yermit#
SUBDIVYSTON ~~ U
F-093
.required r - r
M.ECHAIV.~CAL
Mechanical Corttraetor's Nam : ~~ usiness Name: 5th
Address P D ~7 ~C ~ 3U , ,,,WCity~~"6Y~ State ~ D Zip ~ 3 y,
Contact Phone:•~~ lD~a ~ ~ ~ ~ ~ Business Phone: ( ) /~~S~~Y~-
Email _ ~// ~ ~,, ,... ,.,_ fax -- SIT ~,_..,_ ,.,.
Mechanical >Cstimate $ (CorrtxnerciaUMulti I`arnily Only)
FIX~'U12LS & APPLIANC,i~S COrTN'!' (Single Family bwelling Only)
Air Conditioner ~ Space Heater
Bath Fan Vents
Range Hood Vents
Boiler
Cook Stove Vents
Decorative Gas Fireplaces
Dryer Vents
Evaporative Cooler
Exhaust or vent ducts
C Fuel (gas) piping Iixtures or appliance outlets
Furnace
Furnace/Air Conditioner Combo
heat Pump
Incinerator
Pool Heater
Heat (CExele all that apply) Gas Oil Coal Fireplace; Electric
Unit Heater
~S `•' ` ~ Gf r--~
~sv~-a...e...
1"
Mechanical Sizing Calculations must be submitted v~vith Plans Sz Application
Foint of Delivery must be shown on plans.
,/ Siinaturc pf L'cc;ns
Req uirecl t ~ /
me clr
~~,// 7/
License nunibcr
rlv~-~e i~~U
's Aermit lee schedule is the same as
~~~~/as
Aatc
the -State ofldnho
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