HomeMy WebLinkAboutAPPLICATION - 05-00485 - 4518 Juniper Ave - Gas LineDec 15 2005 9:09RM R-1 Windshield, Inc. 2083567846
Dec. 14. ~2D05 11: ~4AM
• ! No. 1443 P. 3
~C`I~'Y OF' R~BU1~G
BUILDING PERMIT APPLICATION Please 05 00485
19 E MAIN, REXBURG, ID. 83440 If the qu
zos-359-300 X322 ~ S 1 S J uni per-Mechanical
PARCEL DUMBER: / (
SUBDIVISION: ~e~lc+-~ ~~-,~ ~~ -~- UNIT# BLOCK# LOT#
(Addressing .~s based on the information -must be accurate)
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urrlvax ~vgngE: ~- t•; .t,[~~„-,~~r~S"~-~,.~e ~--~ c OONTACT PHONE # ~ U ~"3-S"6~~`6 ~1 U
PROPERTY ADDRESS; ~~h ~ 1S c~ ~,.~, ;~~ ~._
PHONE #: Home (~v~ ~Sd -dgti Y ~ Work ( ) Cell ( )
OWNER MAILINGADDRESS: ~ $ /V'j /Z~'~ --/ CJTY: ~2 a~-:~= STATE: ~/~ZIP:~"s'~/`~D
EMAIL%~./t FAX - - - . 3:StS - ~ ~`C~
APPLICANT (If other than owner) ~ ~ ~ ~ ~ --
(Applicant if txtltet tba:a ovmer, a statement authotiang applicant to act as agenr for awraer mu ~ y p 't:
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APPLICANT INFORMATION; ADDRESS :n~~j, ~nn~
STATE; ~ Z]P EMAIL
PHONE #: Home ( ) Wark ( ) Cell ( Y
CUNTRACTUR: ~_ /? -fin. ~~5~ ~ P ~ S ._ --- --
MAILING t~DD1tESS: z 5/V r / 2 ~ h fr/ Cfl'Y n ~ -, ~ STATE -r`~' ZIPS' ~ yy0
PHONE: Ho'Ine# ddb 3StS ~ ~or~# Cell#
EMA1L ~V~ FAX
How many t~uiiclings are tocaied on this pzoperty? ~
Did you recently purchase this property? ~ Yes (lf yes give owner's ntirne) _
Is this a lot split? ~ YES , (ePlease bring copy of neW legal description of property)
PROPOSED USE: -~
(i.e., Singlo Fatxtily Rcsidence,,MUlti l:tsuaily, Apartments, Remodel, Garage. Commercial, Addition, Etc.)
A.PPI,ICAN'~''S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under peaelry olperjury, t Hereby certify
that I havo read this applicatiar aAd state that tba information herein is corrcet and I swear that arty information which may hereafter be giver- by me
in hearings betore the Planning mtd Zoning Commissiosl or tha City Cwatci) for the City of Rexburg shall be truthfW attd cottsct. I agree to corrrpfy
with all Giry re841etions and Stale laws rclatine to the subject matter o.ftbis application and hereby suWorized rCpresehtatives of tht City to ante:
upon the abovo-mentiioned property for iospectioits pwposes. N07B: 7lre building official may revoke n pcrrrrit on approval Issued under the
provisions of the2000 Intestlational Code in oasts of any false stalemeht or a-isrepreseatation of fact in tho application or on the ,plans on which rho
permit or approval wss bascd~rt~rted within 180 days. Permit void if work stops bar l8D days.
_. _ _rr___~_ DATE
Do you prefer to be contacted by fax, email or ones Circle One
WARNING - BUxI,D1tr1G T BE POSTED ON CONSTRUCTION SITE!
Plan fees ate non•re[uadable snd are pall Ua ltt0 at tre ttma of applieatioa beginalue lmarsary 1. 20BS.
CSty of R~borg'e Acceptaneo otthe plan rttview ita does cot consfitutc plan apprav'I
~•Bnlldhg Perttrlt Fea are due at time of appyicrttioa•a •;Buitdiog Permits arc void ii'you check dt»e not clear••
Dec, 14, 2005 11:54AM •
Please csniplete the entire ,A.pplication! u the yaes OS 0048_5
ap-ps~eie' ~ ~~! - ~-~'=.~~ 451.8 J un~per-M~d. Co. Mech.
// f~~~ _~. ~~~~4__~ll
NAME C.SCJ -~- /~/ ~ ~ Ste" ~ r/~S
PROPERTY ADDRES ~..~ r .~ -~ ~ rx -,~~ ~. r j ~9 Permit#
SUBDIVISION '~ ~3~~~
Required!!! M.~CHANICAL
Mechanical Contractor's Name: ~ - ~~' ~~'°'?l~ Business Name.
Address L j, ~ ~ ;~ (~:~~ ' - City State , ~ Zip ~.~3~- .eta
Contact Phone: (;~(;' ~ t - ~~ ~C~} Business Phone: (~(~~) ~ ~~ ~ ~l~
Email ~~d~ Fax~~-~~
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single .Family Awelldrag 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
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
~A~
DEC 1 4 2005
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply)~G~a Oil Coal Fireplace Electric
CITY OF REX
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
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/"'Signature of Licensed ContraCtrn- - . , `License number Date
The
schedule is the same as required by the State ofldaho