HomeMy WebLinkAboutAPPLICATION - 05-00474 - 4330 W 3800 S - New SFR Mechanical'CIT~° OF REXB URG PERMIT #
BUILDING PERMIT APPLICATION Please COri1p~
19 E MAIN, REXBURG, ID. 83440 If the question doe.
208_359=3020 X322 /~ OS 00474
PARCEL NUMBER: ~ ~~~~ ~~~° Il,~~~ 4330 W 3800 S-Mad. Co. Mech.
We will p~
SUBDIVISION:
UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER NAME: ~ CONTACT PHONE # ;,~.~~~ ~ •~ (~ ~ ~
PROPERTY ADDRESS: '~ ~~t,(J , ~ (~ ~~u-~~
PHONE #: Home Qp~ L„~~~~~4 Work ( ) Cell ~~ ~ ~(~ --(~~,~„~~
OWNER MAILING ADDRESS: ~~{-? CITY: STATEZIP:~~~C~
EMAIL 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
CITY:
FAX
Work ( )
Cell ( )
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work#
FAX
Cell#
STATE ZIP
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?
PROPOSED USE: ~
(i.e., Single Family Residence,
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 of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
/ /_
Signature of Owner/Applicant DATE
Do you prefer to be 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 Regburg'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**
CITY
YES (Please bring copy of new legal description of property)
....,,
YleaSe COrilplete the eritll'e ApphCatlOil! If the question does
applicable
apply fll in NA for trnon j~~ ~ ~ ~fl
NAME ~ ,J ~,e.~~ ~t'~~--~.-C~~.,~
PROPERTY ADDRESS ~ ~ ~~~ ~ ~~'~'"~ Permit#
SUBDIVISION ~ ~
Required!!! MECHANICAL
1
Mechanical Contractor's Name: ~~~~„~ ~~'~ Business Name: , 9~ -~~~
Address ~~~~ ~~ S SD ~ City State Zip_S~~Z
Contact Phone: (~~l ~ ~// 5 Business Phone: (~~~f ~ ~ l
Email Fax
Mechanical Estimate $ (CommerciaVMulti Family Only)
FIXTURES & APPLIANCES COUNT Sin le Famil Dwellin Onl ~ '~ ° °- ~ ~ "''
-~'"Furnace ~?~-~r ; - `~' ~% ~ =~-~.- ~ Exhaust or Vent Ducts
Furnace/Air Conditioner Combo / Dryer Vents `~
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances ,. _ ,~ ~
:" 4
~_ 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
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~ ,_
Signature of Licensed Con actor
The City of Rexburg's
Range Hood Vents
Cook Stove Vents
Bath Fan Vents ~~ ~''
License number Date
fee schedule is the same as required by the State of Idaho