HomeMy WebLinkAboutBP & APPLICATION - 06-00194 - 4657 Cedar Butte Rd - New SFR MechanicalZ ~„' ~ ~ TI Z 'w ys3 „ Ctppo
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CITY OF REXB URG
BUILDING PERMIT APPLICATION Please 06 00194
19 E MAIN, REXBURG, ID. 83440 If the que 4657 Cedar BUtte RC~-Cnty McCh
208-359-3020 X322
PARCEL NUMBER: ~ i (We will provide this for you)
SUBDIVISION: (~"~~l(~ r,~~-k-~t , UNIT# BLOCK# LOT#
(Addressing is basedon the information -must be accurate)
OWNER: ~+'~,:--~- r%r+ ~ CONTACT PHONE # .~ ~. '
PROPERTY ADDRESS: ~ ~ n
PHONE #: Home ( ) Work ( ) Celi { )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT: (If other than owner) h ~ ~G
(Applicant if other than owner, a statement authorizing applicant to act a agent for er must accompany this application.)
APPLICANT INFORMATION: ADDRESS 3 Z $~~`' ~v c d l,,i CITY: .~ w
STATE; ~ ~ ZIP~U EMAIL~~,~~.~~n.~,z~.~- ~ ~r~ AX
PHONE #: Home (~ J~ ~ l 3 c ~' ~ ~ Work ~~) ~ (~ a v~ ~ Cell ~ ~ ~ 0~ ~
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX 2
How many buildings are located on this property? t5
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 pr ert
PROPOSED USE: C ~~ (~ G
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, tc.
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 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 property for inspections purposes. NOTE: The
building offic~ may revoke ennit on ~ proval issued under the provisions of the 2000 International Code in cases of any false statement or misrepresentation of fact in
the applic or o the pl on whi it or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days,1
~/ ~ l / ~(Z
Signat of Owner/ pplicant ATE
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
Ptease complete the ent~ Appllcatlon! If the question doe~ot apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~~ ~ K..~2 ~,ti-~ ~ jc,~~ Business Name: `~ ~'~ ~7rP.,{ ~i'V, LLB
Address .3 2~~ ~ 3 tlQ; ~/ City -t XI~Y'~- State /~ Zip o
Contact Phone: (~~~) 3 j ~ U 1 ~ (t, Business Phone: ( ) _ Sa,,^, ~
Emai1~~,2,1a~+.~~.~i-~ ~~ ~~,..., Fax
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelli g Only)
Furnace ~ Exhaust or Vent Ducts
Furnace/Air Conditioner Combo ~ Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets
' Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply as Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Z1 ~ 1~
~ignature of Licensed Contractor License number Da
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho