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HomeMy WebLinkAboutAPPLICATIONS - 06-00196 - 2464 Diamond H Ln - New SFR Mechanical• • CITY OF REXBURG PERMIT # MECHANICAL. PERMIT APPLICATION Please complete the entire Application! 19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable 208-359-3020 X326 PARCEL NUMBER: (We will provide this for you) SUBDIVISION:.Sc..c~, (~, C.ne~e.l~ ,e.~-, UNIT# BLOCK#j LOT#~ (Addressing is based on the information -must be accurate) CONTACT PHONE # PROPERTY ADDRESS: PHONE #: Home ( ) fit/ Work fl1~i~ 533 -4~SS/!o Cell (Zvi ~~?zr, "13 / OWNER MAILING ADDRESS:~© bo~`~CITY: STATE:~ZIP: ~3t~~(v i EMAIL FAX APPLICANT: (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS STATE PHONE #: Home ZIP EMAIL Work Cell ( ) CONTRACTOR: g MAILING ADDRESS: ~o '~~y n_3 $2, CITY v STATE~~ZIP ~ 4~1 PHONE: Home# d~/ -- Work# S 3 3 - 4 Ste, Cell# 3 / 3 -- S'/ 3 J EMAIL ~tJ~,q---- FAX~~-~-~ How many buildings are located on this property? ~- Did you recently purchase this property? No ~(If yes give owner's name)~~e~l Is this a lot split?~ YES (Please bring copyw legal description of property) PROPOSED USE: ~ ... ~~ (i.e., Single Family Residence, Multi Fami 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 an information which may hereafter be given by me in heazings before the Planning and Zoning Commissio i Council for the City of Rexburg shall be truthful e~ i~e t~o~ y r ~ tions and State laws relating to the subject er oft is ppli ion an hereby authorized representatives of the City to r o e ve nt ne ro ections purposes. NOTE: The buil ng official revo ape it on approval issued under the provisions of the s ment or misrepresentation of fact in th application r n the s o hich the permit or approval was based. Permit vo ~y ed within 180 days. Permit yQ ork stops for 180 days. SEP 1 5 2006 ~~~~~ y ~ FAX CITY: Do yo~iref~ to be contacted by fax, email or phone? C rcj~ ~ ~~~~ WARNING -BUILDING PERMIT MUS B ~ S E Plan fees are non-refundable and are paid in full rv City of Rexburg's Acceptance of the plan review fee does not constitute plan approval • Please complete the entire Application! if the gnestion goes not apply f1 in Iva for non applicable NAME J ~~-~ PROPERTY DRESS ~ ~.,,~,e_. Permit# SUBDIVISION ,~ Required!!! MECHANICAL Mechanical Contractor's Name: ~ ~ Business Name: f/(~ Address ~~',~~~ 3 ~t?~~ City G State /~Zip~~}/a Contact Phone: ('~j°~) ~ (,~ Ey~p"Q~ Business Phone: ( ) ~,,.~./ Email Fax Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace T 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) Gas Oil Coal Fireplace Electric Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. ~. ~~ G Signatur of Licensed Contractor License number ate The City of Rexburg's permit fee schedule is the same as required by the State of Idaho s a • • CITY OF REXB URG BUILDING PERMIT APPLICATION Please c~ 06 ~~ 196 19 E MAIN, REXBURG, ID. 83440 If the questi 2464 Diamond H Ln-Cnty Mech 208-359-3020 X322 PARCEL NUMBER: V ~ (We wiii pruvtuc tni5 iur yuu~ SUBDIVISION: rat ~ s LTNIT# BLOCK#_~_LOT#_,~~,~ (Addressing is based on the information -must be accurate) to PROPERTY ADDRESS: CONTACT PHONE # PHONE #: Home ( ) Work ( ).,5"33 - yS"S/` Cell ( ) ~' /,~ ., S"/~ OWNER MAILING ADDRESS: ~D. ~ $Z CITY: C STATE:~ZIP: ~~l/~ EMAIL FAX APPLICANT: (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS STATE; ZIP EMAIL PHONE #: Home ( ) CITY: FAX Work ( ) Cell ( ) CONTRACTOR: ~ ~' % h ~?~ S MAILING ADDRESS:T~ ~i~¢.~e ~: ~G CITY PHONE: Home# EMAIL Work# FAX Cell# STATETd. ZIP ~3~1~0 How many buildings are located on this property? Did you recently purchase this property? No ~e (If yes give owner's name) Is this a lot split?~ YES (Please bring copy of new legal description of property) PROP U ~ a•^~f (i.., Single Fa esi ence Multi mily, Apartments, R odel, 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 Ciry 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 180 days. / / Signature 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 .,Please complete the enti~Application! If the question doe apply fill in NA for non applicable NAME lg ~L° ~ ~~,~ S PROPERTY A RES ,? ~ ~ '~ ~ e Permit# SUBDIVISION ~'' c~.,~,K ~g Required!!! ,QMECHAN/ COAL cam" ~~ ~ s' ~'~ a td ,,[, , , Mechanical Contractor's Name: Business Name: ~ ~~~ " y Address Contact Phone: Email City State Zip Business Phone: ( ) Fax Mechanical Estimate $ (CommerciaUMulti Family Only) F~RES & APPLIANCES COUNT Furnace ~_ Furnace/Air Conditioner Combo T 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) Gas Oil Coal Fireplace Electric other similar vents & ducts: Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. (Single Family Dwelling Only) Exhaust or Vent Ducts Dryer Vents ~ Range Hood Vents Cook Stove Vents Signature of Licensed Contractor License number ~_ Bath Fan Vents Date ~ The City of Rexburg's permit fee schedule is the same as required by the State of Idaho u