HomeMy WebLinkAboutBP & APP - 06-00192 - 9624 S Snake River Rd - MechanicalZ
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7
CITY, OF REXB URG I
06 00192
BUILDING PERMIT APPLICATION Please co 8624 S Snake River Rd-Cnty Mech
19 E MAIN, REXBURG, ID. 83440 If the questia
208-359-3020 X326 ,~~ ~~ II ~(~pL~
PARCEL NUMBER: ~~~'tly~T , ~ (~~~,~'' ~ (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS: ~LQ ~~ ~ ~~ ~~\ ~~
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT: (If other than owner) ~,l,i~l
(Applicant if other than owner, a statement aut orizing applicant to act as agent fo er must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
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 sweaz that any information which may hereafter be given by me in heazings 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 prope for ins ections purposes. NOTE: The
building official may revoke a permit on approval issued under the provisions of the 2003 International Code in cases of any f to i
the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit d wst~fo 80 ay~~~
/ /
Signature of Owner/Applicant E ~R z ~ ~~
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUC ION ITE!
Plan fees are non-refundable and are paid in full at the time of application beginni g • R EXB U fl 1~
City of Rexburg's Acceptance of the plan review fee does not constitute pl a
•
Please complete the entire Application! If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS ~i~~~-t--~'~1~.t~.~gr4~ Permit#
SUBDIVISION
Required!!!
MECHANICAL
Mechanical Contractor's Name:=-'~ ~~ Business Name: f ~ t~j
t
Address~~ ~ City State~~~ Zip
Contact Phone: ~~ 1 i Business Phone: ~1,-- C~ j
Email
Fax ~~~~ ~` ~.~
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES 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
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Heat (Circle all that apply Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of icensed Contractor License number ate `
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho