HomeMy WebLinkAboutAPPLICATION - 06-00185 - 2837 S 4000 W - New SFR MechanicalCity of Rexburg/ Madiso~'ounty ---
BUILDING PERMIT APPLICATION t~i~ _~~# 06 00185
19 E MAIN, REXBURG, ]D. 83440 i~ cis:- c~ l~•
208-359-3020 X322 ~ 2837 S 4000 W-CClty McCh
PARCEL NUMBER: ~~~~I~ V~, (~ C~
SUBDIVISION: UN11-# _BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: 28 3 7 5. ~-tG60 1N ~~~, ~ ~ 3 c,/ ti t)
PHONE #: Home tzog) 3~ _ 47 t~~-I Work (aoe~ ~ ~ Cell ( ) kd}
OWNER MAILING ADDRESS: 38ZO5, ~ft-113 1.~/. CITY: STATE:,~ZIP: 3y4a
EMAIL ~d1- FAX dl ~'
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing
APPLICANT INFORMATION: ADDRESS
STATE; ZIP,
PHONE #: Home
to act as agent for owner mast accompany this application.)
CITY:
EMAIL
FAX
Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS: /~f y 8 /lI. ~fODU ~t/. CITY STATE~~ZIP 3 4u 0
PHONE: Home# ~ - 54 99 Work# 310 - SZI97 Cell# 39D - S~f 97
EMAIL yG~tN , F ti~~~!l~~Ax NJft
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 YES (Please bring copy of new legal description of property}
PROPOSED USE: ~ ~
(i.e., Single Family Residence, Mu i Family,
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1
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 I80 dais.
~y ~ ~~,~~~ ~~ lz ~ o~
Signature of Owner Applicant DATE
1)o you prefel• 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 st the time of application beginning January 1.2005.
City of Reaburg's Acceptance of the plan review fee does not constitute plan approval.
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NAME ./~ ~~~yj~~
PROPERTY ADDRESS o 7 Lf~ Permit#
SUBDIVISION _/~~
`c~~c~r~cl ~ ~ i
MECHANICAL
Mechanical Contractor's Name: ~~ ~~ (,t~o'd Business Name: /~),~o [,(J~ /~ ~~
Address pQ. ~R~/~~ City State Zip 3y~~
Contact Phone: ( ) ~~n _ rn(~~ q Business Phone: (20$) 3~jb- ~rp~ ~
Email ~ ~}" Fax ~ ~
Mechanical Estimate $ ~5~ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
_y~ Furnace ~_ Exhaust or Vent Ducts
_~~ Furnace/Air Conditioner Combo ~ ~_ Dryer Vents
~_ Heat Pump ~ Range Hood Vents
r~ Air Conditioner ~~ Cook Stove Vents
~_ Evaporative Cooler ~ ~_ Bath Fan Vents
~_ Unit Heater ~_ other similar vents & ducts:
~,~ Space Heater
2 Decorative gas-fired appliance
~_ Incinerator System
~_ Boiler 1~r~ ~ bo•~a~ $ 4 3 ~ ~ ~
~_ Pool Heater 35Ia~ yNbo 1~eXbW9 r .Gd• g3~lNa
go -
~_ Similar fixtures or Appliances ~ %~,~ (~~
~ic.Gh.S '~ ~ a'~~
"~ Fuel Gas Pipe Outlets including stubbed in or f~ut~ure outlets
~_ Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply Gas it Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~~
`~i~~,~~zit~u•;; ut"l,i~:~,nsed ~.'tn~tr.lcls~~' Licen~~ »i~K»~~:r Date
its ;.~ ~~ i,•~~~i ~
The City of Rexburg s permit fee schedule is the same as required by the State of Idaho
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