HomeMy WebLinkAboutAPPLICATION - 06-00171 - 3720 Mountain View Dr - Mechanical• .
CITY OF REXB URG pFRMiT # ~ Q~ i
BUILDING PERMIT APPLICATION Please co
19 E MAIN, REXBURG, ID. 83440 If the questii 06 001.71
208-359-3020 X322 3 720 Mountain View DR
PARCEL NUMBER: ~ ~~ y~T 1/~~f~/()O~t~ (We
SUBDIVISION: UNIT# DLVViin _
(Addressing is based on the information -must be accurate)
OWNER: v ~ ~ /~_J" CONTACT PHONE # 3 f ~- ~.~
.S~i ~ .~ ~4 ?'
PROPERTY ADDRESS: ,3 ~7p G/, /~T. y~u%j 1~~, ~~ ~y ~-t=~~t ~-~ ~~~"~ ~6..5.~`A. /~/ ,
PHONE #: Home 2(°~) 3.1~- ~0 / Z_ Work ~°X) ~ /~ ~~-~;j~ Cell (~`~~') 3 /.1-~6J^7
OWNER MAILING ADDRESS: S~ ~-e,, CITY: STATE: -ZIP: ~--
EMAIL r~G'~l f~. ~,tl FAX ~ ~• ~.~~~.I-~ ~ n ~ l~'~ ~ ~ ~ L5 I ~ I~
APR 0
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must
APPLICANT INFORMATION: ADDRESS
STA
PHONE #: Home ( )
Work ( )
CITY:
FAX_
Cell ( )
CONTRACTOR: ,ti
MAILING ADDRESS: STATE ZIP
PHONE: Home# el
EMAIL
How many buildings are located on this property? ~ a ti~_
Did you recently pur~ch~ase this property?~ Yes (If yes give owner's name)
Is this a lot split?~... % YES (Please bring copy of/new legal description of property)
PROPOSED USE: S`Td~4~e. (~,~--~
(i.e., Single Family Residence, Multi Family,
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 ~1 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 t ~ cation and h authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The
building o ~ ay revoke on approval issued under the provisions of the 2000 International Code in cases of any false statement or misrepresentation of fact in
the a ion or o~ ans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work/st/ops for 18/0~d`ays.
gnature of Owner/Applicant 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
ZIP EMAIL
Please complete the enti~Application ~ If the question does apply fill in NA for non
applicable
NAME /~~ JG~@~..5 ,/~
PROPERTY ADDRESS 3 ~~ ~-~, /~'~ L~?~,J ~ . 0` ~~ Permit#
SUBDIVISION iVbtiQ,
Required!!! MECHANICAL
Mechanical Contractor's Name: ~ti, ,- ~ ~3`~vr, Busin//ess Name: ~~ ~~~7 O
Address ~~( ~V y~zi~ City b State ~ Zip ~~ .
Contact Phone: ( ) ~'J~ " ~ ~~ C~ Business Phone: ( ) ~~ y7- ~~ ~ b
Email !U~/~ Fax ti~~
Mechanical Estimate $ ~~ (CommerciaUMulti Family Only)
FIX~URES & 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 apply) Ga Oil Coal Fireplace Electric
S1~~~-sue
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
____~---~--~-aint of Delivery must be shown on plans.
Signature of Licensed Contractor
L
License number
~~'a6
Date
The City of Rexburg's
schedule is the same as
the State of Idaho