HomeMy WebLinkAboutAPPLICATION - 05-00450 - 2737 W 1000 S - New SFR Mechanicalfir' 1 ~ OF REXB URG ..,~.,_,_.,, 0~ 450
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BUILDING PERMIT APPLICATION Please Mech
19 E MAIN, REXBURG, ID. 83440 If the qu 2737 w l OOO S-Mad. CO.
208-359-3020 X322
PARCEL NUMBER: Q,PO~o~~'~~.~~~( We will provide this for you)
SUBDIVISION:
UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE # ~~ ~S"~ 356 3
PROPERTY ADDRESS: ~7.~~C-t.-~ j~da
PHONE #: Home (?~_~ ~ -- 3 S ~ 3 Work (.mss) .~5~ ~~/Cell ( )
OWNER MAILING ADDRESS: 7'a c~y S•~`` G~ CITY:~~,l~'y,~ STATE:~~ZIP:~~a
EMAIL ~7; iS~ ~~~ FEZ ~~FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home
Work ( ) Cell
CITY:
FAX
CONTRACTOR:
MAILING ADDRESS: ~~I~1L ~.~-~•->,r~~ CITY /. ~ STATE lI> ZIP ~~a
PHONE: Home ork#-~ 3g5~e11#
EMAIL
FAX ~ ~-3 3 ~ ~
H»w many buildings are 1»cated nn this nrc-nerty?
Did you recently purchase this property? No (If yes give owner's name)
~.~ I ~a'
Is this a lot split?~N~ YES (Please bring copy of new legal description of grope
NOV Y 6 ~~05
PROPOSED USE: ~,
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, c.)
Y
__.
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 o~'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 royal was lamed. Permit void if not star~d~yvithin 180 days. Permit void if work stops for 180 days.
Signafu?~of Owr
Gr ~,/S l~
DATE
Do you prefer tc~ b~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 Rexburg'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**
complete the
applicable
~,.~-
Orin If the question does not apply fill in NA for non
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~ ~~, Business Name: ~~,~,~\~ i
Address 1~ ~ ~ • City~~,1~ \ (~`~~ State ~\~ Zip`~~
Contact Phone: (ZOO) ~ Z3 - 3~,c}-~ Business Phone: (2~) SZ3 - 38 4~ (4 ~S ~` ~~
Email Fax ~ LaSS~ SZ3 ~ 3 Rco 4
~~
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only) ~~;
~_ Furnace -~~ ~ ~j ~_ Exhau'sf or Vent Ducts `~
Furnace/Air Conditioner Combo _ C ~ Dryer Vents t~
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance `~ ,
Incinerator System
Boiler
Pool Heater
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) as Oil Coa ire la Electric
~~
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
ature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho