HomeMy WebLinkAboutAPPLICATION - 05-00465 - Premier Powder Coating - MechanicalNOV-23-2005 09:56AM FROM-FALL RIVER ~TRIC
CITY OF R.~,,,YBURCr
BUILDING PERMIT APPLICATION Ply
19 E MAIN, RExBURG, ID. 83440 llf tll
208-359-3020 X322
/"J rib ~ D c~u^
P.001/002 F-462
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PARCEL NUMBER: '~~~11J ~ ~ I ~ ~~ `1 l1~ We will provide this for you)
SUBDI'V'ISION: UNIT# BLOCK#~LOT#
(Addressing is based on the: information - must be accurate)
CONTACT PT-TONE #
PROPERTY
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PI30NE #: Home ~ (~' 7d j ~~ -7(6,~r Work ( ) Cel] ~1-~~ ~I ~ ~1~~ ~C~
OWNER MAILING ADDRESS: ~ N-"~ CITY: _ _ _ STATE: ZIP:
EMAIL I'AX
APPLICANT: (If otkler than owner)
(Applicant if other than owner, a statement authorizing applicant to aci as agent for owner mint accompany [his application.)
APPLrCANT INFORMATION: ADDRESS
STATE; „ „ ZIT'
P~TONE #: Home ( )
208-652-7625 • T-563
05 00465
3438 N 3000 W
CITY:
EMAIL FAX
Worl;
Cell
CONTRACTOR: -~Tt =~ .~ .(~f,~r~/~. ~-~,~~~u~.~:
MAYI.ING ADDRESS: p0 ~~ ~3;~~1 ~ CITY ~ STATE ~~ ZIP~~'~~'
PHONE: Home#,~~I Wark# Cel1# -~~- 7D`~= ~,~ ICJ
EMAIL. FAX.~~ -1~~5"
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? NO YES (Please bring copy of new legal description of properly)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
AFFLICANT' S SIGNATURE, CERTIFICATION AND AUTfIORIZATION: Under penalty of p4tjury, T hereby certify that I
havo read IhiS application and stare that the infm'tnation herein is correct said d swear than any inForma[ion which may herca$er be given by me in hearings bofore the
Planning and 7~ning Commission or the City Council for the Ciry of Rexburg shall be truthful pod eotr<!Ci• T agrez to wmply with all Clty te$ulatiuns and State laws
trlstirtg ro tha subject mattrr of this application and hereby authorized representatives ofthe Ciry to enter upon nc~ above•mentionedprnperty for ingp4Ctions putposcs,
NUTP; The building ofilcisl may revoke a permit on approval issued finder [he provisions of the 2000 ImesmatinrtAl Code in cases of'sny false Stalkment or
misreprescttration of fact .n the application or on the plans on wh~eh the permit or approval was based. Permit Ycid if not stancd within t SO days. Permit void if wm~k
~tnps for 180 days,
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Sign [ure of Owner/Applicant DATE
Do you prefer to be Contacted by f"ax, email phone? trcle One
WARNING - BUILnrNG P$ - ~ST BE POSTIFI) ON CONSTRUCTION SITE!
plan fees are non-refundable and are paid in full al the time of application beginning ,/anuarY 1, 2005.
City of IZuxburt;~s noccptancc ofzhc plan review fee c[ocs nut constitute plan approval
NOV-23-2005 09:56AM FROM-FALL RIVER ~TRIC 208-652-7825 ~ T-563 P.002/002
~le~Se CUm~11Cte t~le entll'G A,~~1~~Gs`itlOll ~ if the qucsCion does not apply ill in NA !'or non
. :~pplicaUlc
Nt1ME ~ ~ ~
PRQFERTY AD R.l~SS ~ 5~7O !'? ~ D~G~ Gti Q.i/x~<Z~'Luf Permit#
SUBDIVISION /
F-462
Required ~ ~ r
MECHANICAL
Mechanical Corarraetor's Name: Business Name:
Address
Contact Phone: ( )
Email
_City __ _ State Zip
Business Phone: ( )_ ,,,,,
Fax
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES ~ APPLIANC,ES COUNT (Siirgde Family Dwelling Ondy)
Air CondiLione;r Space Heater
Bath Fan Ul-'.ntS Unit heater
Range Hood Vents
Boiler
Cook Stove Vents ~~
Decorative Gas Fireplaces < <, ~~i~
Dryer Vents
Evaporative Cooler
Exhaust or vent duals
Fuel (gas) piping fixtures or appliance auclets
Furnace
Furnace/Air Conditioner Cotxtbo
Heat Pump
Incixaerator
Pool Heater
Hcat (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.
Sig t ro o tense Cpntr~le[or Liceusc numbLr Date
lzequired!
The City of Rexburg's permit fee cchn_dule i.s the same as rcquirecl by tlae Mute of'Idaho
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