HomeMy WebLinkAboutAPPLICATION - 06-00139 - 2649 Little Town Dr - New SFR Mechanicalz
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City of Rexburg/ Madiso~'ounty
BUILDING PERMIT APPLICATION (~~:~l>~~~ ~ 06 X01 ~~
19 E MAIN, REXBURG, ID. s344o ~~a z~~~, ~l~~g' 2649 Little Town Dr-Cnty Mech
208-359-3020 X322
PARCEL NUMBER: ~-~ `~ 1-.G ` Q~~ ~ ~) (~~ ~ ••--- r--- • ---_ ------ ___ , _
SUBDNISION: t- , ~rY ° 4l UNIT# BLOCK# ~ LOT# ,~5
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: X2(,4`1 l.a~~ ~~~ ~ ~,~~ -
PHONE #: Home (~?~) 35`~ - 5~S o Work ~~ - 5 4~yC? Cell
OWNER MAILING ADDRESS:~~ ` It:,,~c,v~ fir. CITY: ~ STATE:~ZIP: &°~`~`~
EMAIL ~k v~ IC; r~ ~l~"`°` iF~~'~% > ~'
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner mast accompany this application.)
APPLICANT INFORMATION: ADDRESS.
CITY:
STATE; ZIP EMAIL FAX
PHONE #: Horne ( ) Work ( ) Cell ( )
CONTRACTOR-
MAILING ADDRESS: ~, ~ ~ ~~ ~i E . I.'t t vJ '~;- CITY e >L STATE ~ ZIP `~3iry~
PHONE: Home# Work#,3,~ ~ - S~~Uu Cell# 3i 3 - ~ ~~5
-'-~~~FAX 5` .- ~`
EMAIL ; brc~~~ ~ ~ ~_
How many buildings are located on this property?
Did you recently p~urachase this property? No es If yes give owner's name)
Is this a lot split?~Dio YES (Please bring copy of new legal description of property)
PROPOSED USE: ~t ~ Ic ~z.ti.~-~ << ~;~ i
(i.e., Single Family Residence, Mul i Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1
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 i2exburg 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 1 g0 days. Permit void if work
stops for I80 days.
,/~ ~~~ D 6
Signature of OwnerlTicantf/
Do you prefer to be contacted by fax, entail or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CON.
Plan fees are non-refundable and are paid in full at the time of application
City of Reaburg's Acceptance of the plan review fee does not constitute ply
/ ,
DATE _
,d~~
2 0 2006
2
?`~'<~~a ~.'~~111~)~f.',~t' lflt= l"tl~' ~'~~~)~i~.;.~t~l{.DC~~ {t't~~w,;exe:~tit~~~ilt~tul.i~j~a~~ iii~l~ i~±.i C~~t'9~a~i~
NAME ~~~ ~12Y1
PROPERTY ADDRE S r n ~- f35- ~,}~ ~yW't~ ~d , Permit#
SUBDIVISION `".c.~ _~~ (d~t~IC
~~jc~c~zr~~~l >! MECHANICAL
Mechanical Contractor's Name: 1 Business Name: `1 W
Address City ~. C,~ +:'~~ State~~ Zip ~ 3yUy
Contact Phone: ( ) Business Phone: (o?~S) ~e9- y 6 50
Email Fax
Mechanical Estimate $ 5a ~ _ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
FurnaceL 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:
~_ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
:l.'34,IY1~U1~; Ut~~.iCi)i?S.'_'C~ ~~~~)31~i's1C101' ~.1GfyilS+, I1LUllbz;I'
~~t ~ _, ~ a~ i~•+~ci ~ ._~
Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho