HomeMy WebLinkAboutAPPLICATION - 06-00145 - Triple A Landscaping - MechanicalCITY OFREXBURG ~ 000145
BUILDING PERMIT APPLICATION Pleas Triple A Landscaping '
19 E MAIN, REXBURG, ID. 83440 If the q~ e
208-359-3020 X322 2674 S 2000 W
PARCEL NUMBER: ~ ~~ ~ ~ ~ //~ ~ ~j(),~ ~ (W e will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: Shr }~~~ CONTACT PHONE # 3 - ~ - ~ ~ ~ 3
PROPERTY ADDRESS: a ~ ~S S. ~~C Vil ~~h~ ~
PHONE #: Home ( ) Work ( ) Cell ( ) 3 I ~ - 3 ~ ~ 3
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT (If other than owner) ~ ~~~' r~
(Applicant if other than owner, a statement authorizing applicant ~ /~~"/
APPLICANT INFORMATION: ADDRESS
STATE;
PHONE #: Home
Work ( ;
mpany this application.)
CONTRACTOR: ~~
MAILING ADDRESS: ~ ~ l y ~`~~~ Aj , ~ CITY r - ~J STATE.I.~ , ZIP d'3L/f(/U
PHONE: Home# ~~ ~ `JG1Y-3`Work# J' ~ - 1 Cell#
EMAIL
ZIP EMAIL_
FAX
How many buildings are located on this property?
Did you recently purchase this property? N~ 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: ~ ~1~e~C aC~y
(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 o wne /Ap cant 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 Rexburg'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**
Tease complete the ent~ Application! If the question dot apply fill in NA for non
applicable
1.
NAME ~ ~~`dL r/ / ~ ~ ~Q
PROPERTY ADDRESS .~ '`j ~~o ~,~,~ Permit# n„~
SUBDIVISION " f
Required!!! ~~MECHANICAL
~~`~~~ /
Mechanical Contractor's Name: ~ ~.~'-~ Bus~ess Name:
Address
Contact Phone: ( )
Email
City
State
Business Phone:
Fax
.\
Mechanical Estimate $ ~ D (Commercial/M lti Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling 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
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that appl Gas it Coal Fireplace Electric
of Licensed
The
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Zip.
g Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
License number Date
's permit fee schedule is the same as required by the State of Idaho
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MAR 2 1 2006
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