HomeMy WebLinkAboutAPPLICATION - 05-00484 - 2078 S Fork Cir - New SFR Mechanical` C`I7 Y OF REXB URG ~ PERMIT #
BUILDING PERMIT APPLICATION Please corn'„'~~^ '~~^ °„*"~° "„'~~'^~*'^'' ~
19 E MAIN, REXBURG, ID. 83440 If the question
208-359-3020 X322 c C OS 00484
PARCEL NUMBER: ~,Q(n t7dT ~(~~~~ (We v~ 2078 S FOrk Cir-Mad. Co. Mech.
SUBDIVISION: UNIT# ~L~~~„~ ..
(Addressing is based on the information -must be accurate) ~~~ ~t,~d~i~~
OWNER NAME: ;~~;~~ ~"~ ~ C~v1,p=~~ ~,~ ~°~ CONTACT PHONE # ~ ~ 1 ~ ~-~``
PROPERTY ADDRESS: a~1~ S ~ ~~(~ ~;~~
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
Work ( )
CITY:
Cell ( )
STATE: ZIP:
~.
accompany this applic
FAX
APPLICANT (If other than owner)'
(Applicant if other than owner, a statement
APPLICANT INFORMATION: ADDRESS
STATE;
to act as agent ~r owner
ZIP EMAIL
PHONE #: Home ( )
Work ( )
FAX
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? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, 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 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 Rezburg'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**
y ..
Please complete the entire Application!
applicable
NAME ~- ~~,~~,~~~ ~'.~"'~1
PROPERTY ADDRESS
SUBDIVISION
If the question does'not apply fill in NA for non
~.__W.._._~_._____.__..-.Permit -- _
Required!!!
MECHANICAL
Mechanical Contractor's Name: ' ` ~lU`J ~ 'c' .v'~1n~{j~ usiness Name:
Address City ~ State
Contact Phone: ( )
Email
Business Phone: ( )
Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL9NCES COUNT (Single Family Dwelling Only)
Furnace ~ Exhaust or Vent Ducts
Furnace/Air Conditioner Combo ~ Dryer Vents
Heat Pump ~ Range Hood Vents
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
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Zip
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
I ~.
Signatwe of Licensed Contractor License number
<, ~-~-
Date