HomeMy WebLinkAboutAPPLICATION - 05-00478 - A-1 Windshield - MechanicalDec 08 2005 12:lOPM R-1 Windshield, Inc. 2083567846 p.3
Dec. 8. '2805 10:20AM • • No. 1411 P, 2
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. `CITY OF RF.XBURG PEP' """ `~
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BUILDING; PERMIT APPLICATION Please coilo
l9 E MAIN; REXBURG, ID. 83440 Tf the question ~ 0~ 00478
208-359-30?OX322 ~,` A- 1 ~~illdshield-Mechanical
PARCEL NMJIVIBER:~(~~9 V ~~~~~~~~e wi
SUBDIVISION: UNIT# BLOC7C# LOT#
(Addressing is based on the information -must be acctu~ate)
•~ O 2.rt ~ CONTACT PHONE #
PROPERTY ADDRESS:. _2-S /~ ~ / 27 ~ ~
PHO1V'E #: I1oma Ga~- 3S6 - S~6K0 Work (a~; 3S6 - ~ii~D Cell ( ) d Qa -3s/ ~~0 0
OWNER MAILING ADDRESS: Z J /~ ~ 12~h ~l CITY: ~~~ STATE: ZIP; ~~~~`~~
EMAIL ./~~~-' FAX 2U. ~ - 3S 6 ,~-8 ~tS
APPLICANT (If other than owner)
(Applicant if other tbaa owner, a statez~aent auttaorizi»g applicant to act as a~etnt for owner
APPLICANT' INFORMATION: ADDRESS
STATE; ZIP EM,
PHONE #: Rome ( ~ Work
Cell
,_,
L.
GUIYTKA(aOIiC:__ [SCJ .~/~./~~'~i-,.~..~'S
MAILING ADDRESS: 2 s N ~/ ~7 `' L/ CITY of r..r STATE.-i~,G ZIP S-~yyD
PHONE: Hotne# 2 4~ 356r- ~ 'Work# Cell# ~s/ - y 0 O
EMAIL ~t/'~4-- F,4X 3 S 6 - 7zS y6
many buildings are located on this property?.
Did you recently purchase this properly?~ Yes (lf yes give owner's name)
Is this a lot split?~ AYES/ lease bring copy of new legal description of property)
PROPOSED;USE: f7~Y e G~. ~~~' -~
(i.e., Single Ftniaily Residence, Multi Family, Aparttneuts, Remodel, Garage, Comruercial, Addition, Etc.;
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTkIORIZATION: 'Urxdes penalty ofpetjury,l hereby certify
that I have read tlils application and start that ffic infammtion herein is ootrect and I swcu that any information which shay hereafter be giveft by me
in beatings before the Planning and ''/.oztiug Coirxmission or tha City Council forthe Clty ot'Rc~burg shall be truthful and correct. 1 agree to comply
with 811 City regulations and State laws slating to the subject manor of Ibis application and hereby authorized representativcs of tlae Ciry to Bazar
upon the above-mentioned property for inspections purposes. NO'I~; The building official may revoke a permit on approval iasutd under the
Drovisions of the 2000 International Code incases of any falso sra[etneat or miSreRtesenta4o11 offan i.a the application ar on the plans on which the
permit or approy 't void ifnot starttd within '180 days. Pcrmil void if wozk stops for 180 days.
~2 ~ ~~Q~
S' lure of OvmerlApplicant AA'I')=
o you prefer to be contacted by fax, email phon Circle One
WARNIIVG - BUILDIlVG P 3T BE POSTED ON CONS1ZtUC?ION SITE!
Plan fees are nou-refaodable !ad art paid in !loll at tha time of appli~atlon DeglnoingJaau~arr 1. ~OOl.
City of Re+tburg'a Aeeeptaaee of the plan review fee does oot constiituta plan approval
•oBuUdhtg Parmit Faa Are due at ttoae of application+~ a`Buildiag pornits are void if you etaeek does not elaar++
Dec 08 2005 12:lOPM A-1 WindsFiield, Inc. 2083567846 p.2
_ Dec. B. 2005 10;20AM • ~ No. 1411 P. 3
~ ~
~-.~ ~n.w~r~rMwwY~eY1+~ u.+M+~wo+•w
ease c , mp e e e en re pp Ica ><on. u the gnestfon does not apply fill In NA for non
appllcabl~
NAME ~ ~ ~IJ t/ ~ S ~""~ ~. hJ.'I.' S
PROPERTY ADDRESS Z ! 12e~°6 `~3 ~~ Perrnit#
SUBDIVISION ,~
Required!!!
MECHANICAL
Mechanical Coatxactor's Name: ~'0 =~+~ts~.He.~'~-S' Business Name: ~ -~h /eS"~'i"'e "~
Address 2S N ~ /Z"~' City ~ C~ "~ °~ State ~ ~ Zip ~ 3 W 4IS
Contact Phone: (~ 0p) ,356 " $6 ~ ~ Business khone: (~t0~ 3S 6 - ~ 6Y D
Email ~l~ Fax ?~ ~' 3 5 6 '- ~ 8 iF ~
Mechaafcal Estimate $ ~V ~°~ (ConnmercisllMnltiFami]y Oaiy)
FIXTURES ~ A.PPLIANCES COUNT (Slagle Family Dwelling Only)
Furnace Exhaust ar Vent Ducts
Furnaoe(Air Conditioner Combo
Haat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pgol Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Feat (Circle all that apply) Gas Oil Coal Fireplace Electric
~~
\ V ` `J
Mechanics] Siizing Calculations trust be submitted witbt Pland & Application
Point of Delivery must be s6awn on plans.
Signgtun ofLicensod Co~otactoir Liconse mamber
The Ciy of Recburg's,permil jee Schedule is the same as
~~-~ ~S
Date
the Stare ojldaho
bryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts;