HomeMy WebLinkAboutBP & APPLICATION - 06-00162 3060 N 8000 E - New SFR MechanicalZ ~'
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CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
CITY
PARCEL NUMBER: ~~~~~~~ ~~We will provide this for you)
SUBDIVISION: ~ UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS: ~ C~ 6 0 j1
PHONE #: Home ( ) _~5~~ S7 K y
OWNER MAILING ADDRESS:
EMAIL
FAX
Please ~,
If the que; ~ 060 N 8000 E-Cnty Mech
CONTACT PHONE #
Q ~~ i~
Work ( )~~5~ S~~(~'Cell ( ) .3 ~,~~ ~~
CITY: ~~~ STATE~ZIP: R3~cjo
APPLICANT: (If other than owner) ~~ ~ ~ ~7 YZ~, ,L ~ (r
(Applicant if other than owner, a statement autho zing applicant o act as a t for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 3 Z~BiV ~~ ~ CITY: ~{-/~ 6 ~.
STATE• r ~ ZIP__~~(~MAIL ~~ z ~~ a Lc~~
,~v ~ ~ ~4~ ~ FAX
PHONE #: Home •~~) ~ 13 Ott ~ Work ~ ~~) ~ ~~ (~ y6 Cell (~~ ~ /~ ~ ~ ~ ~
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work#
FAX
Cell#
06 00162
STATE ZIP
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 re ke a ennrt n ap'~roval issued under the provisions of the 2000 International Code in cases of any false statement or misrepresentation of fact in
the application or opti~la~n h tlle~ermit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
DATE
h t~ ~. ,.a,ri_.
B
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
Please complete the ent~ AppllCatlOnl If the question doe~-t apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
~~MESCH~NICAL
Address ~Z, ~~ ~y ~U ~ 0 ~ City ~~{'~ ~
Contact Phone: ~%~g) ~ j3 ~~ (, Business Phone:
Email ~~,~, ~ ~ ~~ ~~ ~ -f- ~ ~~ ~ ~ - G:.n Fax ~-
T
ass Name: ~~F-~ ~~ ~ t~ z-~ ~-
State p Zip~~~~-~J
~) ~ ~ 3 0 c/cJ ~,
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwe ng Only)
Furnace Z-- ` ~ Exhaust or Vent Ducts
_~ Furnace/Air Conditioner Combo < Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
,.3 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
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~,
J
Si ature of Licensed Contractor
The City of Rexburg's
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
~`"
License number
schedule is the same as
Dat
the State of Idaho