HomeMy WebLinkAboutAPPLICATION, BP - 06-00165 - 4000 S 5500 W - New SFR MechanicalZ
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CITY OFREXBURG 06 00165
BUILDING PERMIT APPLICATION Please 4 S 5500 W-Cnty McCh
19 E MAIN, REXBURG, ID. 83440 If the que
208-359-3020 X322
PARCEL NUMBER: Q ~ (We will provide this for you)
SUBDIVISION: ,~- UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
'ACT PHONE #
PROPERTY ADDRESS:,~~ j, J ~ tn~ ~ KQ~c~rd
PHONE #: Home ( )~~~ Work )~~ ~7~-~ Cell
OWNER MAILING ADDRESS: ~~$ ~- . ~ h~ ~ CITY:
EMAIL ~~~ ~~}-~j, ~I S ~ . (d~t~FAX ,~
~~
I
STATE:~ZIP:~
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE;
ZIP EMAIL
PHONE #: Home ( ) Work
Cell
CONTRACTOR: ~ ~~-.-_.__....~ _...,..,_
i
MAILING ADDRESS: CITY ST~ ' ~'
PHONE: Home# Work# Cell# ~L MAR 3 1 2006 ~#
1-
4
EMAIL FAX B
Y
TT____________1____'1 J___-_ ____ 7___~_~ ___ ~l___ __________a_fl 1
nV W illdlly V UIIUlI1~J diG IU~:ALGU UIl LI11J ~rU~Clty
Did you recently p hase this property? No I'e (If yes give owner's name) ~ S'
Is this a lot split? NO YES (Plebe bring c y of new legal description of property)
PROPOSED USE: ~r~ai~ ~~i w" ~Qvi~nCP_
(i.e., Single Family Residence, Mini Family, Apar,Cments, 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 o ~al may re ke 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 appli i or on tans 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/App scant ~ DATE
Do you prefer to be contacted by fax, email o phon ?Circle One
WARNING -BUILDING PE UST 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
CITY:
FAX
y
Please complete the enti~-Appllcatlon ~ If the question does apply fill in NA for non
applicable
NAME `~~ W ~ ;~~~
PROPERTY ADDRESS k,l Permit#
SUBDIVISION /r/~/~-
Required!!! MECHANICAL
Mechanical Contractor's Name: l " ~ Business Name:
Address
Contact Phone: ( )
Email
City.
Business Phone: ( )
State Zip
Fax
i
I~ Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
', Furnace % Exhaust or Vent Ducts
I!,I Furnace/Air Conditioner Combo ~ Dryer Vents
Heat Pump ~ Range Hood Vents
~, Air Conditioner Cook Stove Vents
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) Ga 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.
I~~
Signature of Licensed Contractor
The City of Rexburg's
License number
schedule is the same as
the State of Idaho
~ Bath Fan Vents
Date