HomeMy WebLinkAboutAPPLICATIONS, BP - 06-00183 - 159 S 4000 W - MechanicalZ ~ ~ ~ Z •_~ • 1, a ~ Ct rp0
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C.~t~ of Rexburg/ 11~adiCounty PERMIT #
''~ ~ BUILDING PERMIT APPLIC ON ~ ~- -a_ ~ ~.~ ~~~ ~_ _ ..~ .. a . _,
~y~~
..
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322 ~6 ~~ 1 g3
PARCEL NUMBER:~1~~I~~V/ i G ~1~ ~.(w 159 S L~~~~ ~V_Cnty Mech
SUBDIVISION: LJNT
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home ~ ~ G~~f (~~' Work ~j ~,~ ' ~,~'~~ Cell Q~ (,~~~ '~~
OWNER MAILING ADDRESS:~~'a~ ~`~~~~ I'~I CITY: ~ ~ STATE;~ZIP:~~;
EMAIL FAX (~~~ ~~,~ ~~ )?~ \
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner mast aceompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; ZIP,
FAX
PHONE #: Home ( ) Work ( ) Celi ( )
CONTRACTOR:
MAILING ADDRESS
PHONE: Home#
:~~~ N. ~I~ ~~ ~ _~ CITY ST
Work# Cell~w~" ~
EMAIL FAX
A ZIP ~~~~7~
How many buildings are located on this property?,
Did you recently purchase this property? No ~(If yes give owner's name)
Is this a lot split? NO (Please bri,Ilgco-p/y of new legal description of property)
PROPOSED USE: ' ~ ~ ~'
(i.e., Single Family Residence ultl Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, t 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 the in hearings before the
Planning and Zoning Commission or the City Cotttteii for the City of ltatbttrg shalt be truthful attd cornetx. I agree to ~npty with all City tegulatiorts and State taws
relating to the subject matter of this applic~ion and hereby atrthoriaed represattatrves of the City to eater upon the above-tndttioned properly for inspections purposes.
NOTE: The building official may revoke a permit on approval issued under the provisions of the 2000 tntemtuioutat Code in cases of any false statement or
misrepresentation of fact in th~apptication or on the plans on which the permit or approval was based. Permit void if not starttsd within 180 days. Permit void ifwork
stops for 180 day
a 1
Signature ofOwne plirant ' _ 2 ~ n~
Uo yott prefer to e contacted by fa;~, email o phone Circle One 1S ~Yf
WARNAVG - BUII~DING P ST BE POSTED ON C CTYON SITE!
Plan fees sre non-refundable snd are paid in full at the time of appiicati nin~uamrv 1•
City of Rezburg's Acceptance of the plan review fee dose not constitute n pro ~
2
EMAIL
CITY OF REXBURG
.~~~~~5~ CO[11~)~~t~ ~1~ ('Il~ 1~.~)~~~1~~$IOICk~ If`the question dot apply Cll i~a N~~,. ii~r nt~n
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
.l~~~ruz~ecl! , l MEC~IANICAL
Business Name: C ! ~~~~"'
Mechanical Contractor s Name: ~~ ~ ~ , , ~ n I
n ~ ~e 1- SD N City c~ ~t~,~ J ~ State ~ ~ Zip F3f~ I
Address -?~_~ ~
Contact Phone: {~t3F~ S~ 'c1~~3 2.. Business Phone: (20$f " ~'
Email Fax ~ O~ ~ ~ '' / ~ ~ ~
Mechanical Estimate $ (CommerciaUMnlti Family Only)
~'I~TURES & APPLIANCES COUNT (Single Family Dwelling Only) '~
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo ~_ Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
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) Gas Oil Coal Fireplace Electric
c nical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Si~naturc uP ~.ICt, . ,~ Cc>niractor License number Date
Requ' ~ecl!
~ ~ ~ Me~iSry TX Result Report (Apr.13
Date/Time: Apr.13. 2006 10:49AM
20~10.50AM) ~ ~ ~
,)
2)
File Page
No. Mode Destination Pg(s) Result Not Sent
1914 Memory TX 5251374 P, 2 OK
----------------------------------------------------------------------------------------------------
Reason for error
E. 1) Hang up or line flail E. 2) Busy
E. 3) No answer E. 4) No facsimile connection
E. 5) Exceeded max. E-mail size
pqx ~Vq£(G C[YY OF
~ RE~BURG
FAX TRANSMITTAL FORM
Aaieritabltranycomeeurctry (J 22 / I ,,
Cyty ofRaxbecg 7'O: MAM6: 1 y'._X1.i1 _.
P.O- Box 280
19 East Main ~}~. t
COMPANY: (/~. t7f
Phom: (2(206) 359 0~ ~ p
FAX NUb~IDER ~ - J ~ ~f
FAX: (208) 359-3024
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ice 300 9'3 i ~ t3asz Liar for a Dis ~ea of 363.0 Fe
5a~ JV1are or Less.
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'said Section 28;
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iEBpZ ZO~ET 56BZ/9T/0T
AP
. 7 .2006 1.22P ST AME RICAN- RIGBY ~ ;~ ~ N0. 255 P,
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N~''Y EDP .
For a3ue P.eceived, O S. , ~ ma "ed men as sole and eparate~ps'apdrty, the GratQars,
do by grant, sell v~+
D tet ltief and Amp ~ It sba ao~ w
vYh address is
dm xagtee, Cite fiogo cn . preimi , t~-wit
See AEtached ~
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E AND 1'O
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u~o the said Grantees, ~tbe"s heQS and assigns
_ And tlu sal Giant rs layrq~yr pveoant to aad widr a said GFaater3, that thex are the owners in fee
sta ple oP said that sae ~ s free from all cncur ~brances iexc the 20fl5 taxes and assessmenrs
and ibaz ~tey will an d d tbye s from a111a~Yfg1 claim s whatsge~er.
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O this 1~ day o , Z 5 before me L_p~er NAOVtY ~ a notary public is and for said
S t:, personalty ap S ,. h1 latorvs or identif[ed. tb me to be rte persons
w e names are sa w ' ' i» i trtanen and aalasow god to me rba't they executed the same. ,
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