HomeMy WebLinkAboutAPPLICATION - 05-00455 - 2221 Robison Dr - New SFR MechanicalCI~~' OF REXB URG
BUILDING PERMIT APPLICATI ~ Pleas
05455
19 E MAIN, REXBURG, ID. 83440 If the ~ 2221 Robison Dr-Mad. Co. Mech.
208-359-3020 X322
PARCEL NUMBER: R,~~~N~.~l~~ ~~( We will provide this for you)
SUBDIVISION:
UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
n~
ble
CONTACT PHONE #
PROPERTY ADDRESS: of a oZ / JCnp ,~ ($p-,fi,r ~ }''
PHONE #: ~~im (7~/) 3 ~ 4 - Cl`~ Work ( ) Cell ( )
OWNER MAILING ADDRESS:
EMAIL
CITY:
FAX
STATE: ZIP:
APPLICANT (If other than owner) /~?/~"P_ h/,~, l~
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS~~f lj S f .{„?'~~ CITY: ~~ T
STATE; ,~^ ZIP fr3 ~ ~ EMAIL FAX
PHONE #: Home
Work ( )
Cell
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name) ,~/ ~
Is this a lot split?
PROS~,~
(i.e., mgle Family Reside
YES (Please bring copy of new legal description of property)
Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
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 of the 2000 International Code in cases o y false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval wa based. Permit voi ed within 180 days. Permit void if work stops for 180 days.
,~f Owner/Applicant
DATE
Do y~arCi prefer to be contacted b~( fax, email or phone? Circle One
WARNING - B ILDING 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**
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ease com
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~'ll /CP ,~o ~ Business Name: ~~rK~ ~~,V ~~`~~~Cda~:~
Address ~ ~ ~ S j.~~o ~a City S„ ~,, ,,- State .~' Zip
Contact Phone: ( ) Business Phone: ( ) 3~'d.- ~~~ 9
Email
ppllcallon: If the question does not apply fill in NA for non
Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
_~ Furnace ~ Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
~ Dryer Vents
Range Hood Vents
Cook Stove Vents
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) as Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
~._. Point of Delivery must be shown on plans.
~.~~~ ~2~3~ r Z ~ ~ d
Signature of censed Contractor License number ate
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho