HomeMy WebLinkAboutAPPLICATION - 05-00466 - 535 Partridge Ln - Mechanicalr
CITY OF REXB URG
BUILDING PERMIT APPLICATION Pleas l ~
19 E MAIN, REXBURG, ID. 83440 If the q 53J Partrld~e Ln-Mad. Co. Mech. to
208-359-3020 X322
PARCEL NUMBER: ~~(~j ~~ ~ C;~)1 ~ (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: ~4 ~, p CONTACT PHONE # 3 S I Z 6 2..
PROPERTY ADDRESS: S 3S~ t Q ~~' ~-^ ~S~- ~`~"~~-
PHONE #: Home ~- ~4~" Work ~~ 3J ~r °' 7-S'(~ Cell ,` 3,j'"~ ~ ~ ~
OWNER MAILING ADDRESS:~-Q'~X X33 CITY: Q C~utrr STATE:~ZIP: ~3 ~~~~
EMAIL /~~ 0 N~ FAX 1~~~1".
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
CITY:
STATE; ZIP EMAIL
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 es f yes give owner's name)
Is this a lot split NO' YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remo , Garage, C mmercial, 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 cottect and I swear that any information which may hereafter be given by me in heazings before the Planning
and Zoning Commission or the City Council for the City of Rexburg shall be truthful and cottect. I agree to comply with all City regulations and State laws relating to the
subject matter 'cation and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The
building o cial may revoke ermit on approval issued under the provisions of the 2000 International Code in cases of any false statement or misrepresentation of fact in
the applic ion or on the plans which the permit or approva~,w~s based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of
Do you prl
,~ ~
DATE
'be contacted by fax, e'fnail 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 Regburg's Acceptance of the plan review fee does not constitute plan approval
FAX
. ,
,.,~..~.~.A ..~. ",. PP ...... ...q~...x,.~.,~..~..~~ yppy ,......,~_.., _..~~......~...,,~~;....,
~IeaSe COril Iete ~I"le eri lr ~I1Cat10>1. ~If the uestion does not a 1 fill in NA for non
applicable
NAME ~. `t~t~ ~c E'- f
PROPERTY ADDRESS ".~; cx~1-r ~ ~ ~c=. ~-,~C Permit#
SUBDIVISION ~ ~~ ~ r,,./
~!~ Required!!! MECHANICAL
Mechanical Contractor's Name: Business Name:
Address
Contact Phone:
Email
_City
Business Phone:
Fax
State
Zip
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL9NCES 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
~_ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas ~ Oil Coal Fireplace Electric
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor License number
The City of Rexburg's permit fee schedule is the same as
Date
the State of Idaho