HomeMy WebLinkAboutBP & APP - 06-00205 - 2499 N 4000 W - MechanicalZ
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City ofRexbu~g/Madisa~'ounty ~ 00205
BUILDING PERMIT APPLICAfiION i~ 1 ~ ~~ ~ ~a
19 E MAIN, REXBURG, m. 83440 ~~~ ~i~~' ~l~ 2499 N 4000 W-Cnty Mech `3
208-359-3020 X322
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: ~~-~J,~.,.~-. `~ ~ ~---~ e-~ ~~ CONTACT PHONE # ~- 7 ~-s~-~-6C,
PROPERTY ADDRESS:
PHONE #: Home (~~ 7 ~ 4-~ ~r ~ ~ Work { ) Cell ( )
OWNER MAILING ADDRESS:~~ ~ ~o E ~ ~~' CITY: itii ~ Nom, ,,v STATE: i~ ZIP: ~ 3~ 3 ~{
EMAIL ~-~~-~T4~~'"'` 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 #: Horne
Work ( )
CITY:
Cell
FAX
CONTRACTOR: /i'~ ~--
MAILING ADDRESS:
PHONE: Home# Work#
CITY STATE ZIP
Cell#
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property? No es If yes give owner's name) ~..e-~-- r< t.~so
Is this a lot split? 10 j YES (Please bring copy of new legal description of property)
PROPOSED USE: ~~ , ; ~r~-e.-
(i.e., Single Family Residence, Multi Family, Aparhnents, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1
have read this appligtion 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 heroby authorized representatives of the City to enter upon the above-mentioned property for inspeMions puipeues.
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.
~'
.~i_~.i
Signature of Owner/Applicant DATE
loo you prei~er to be contacted by fa;c, entail or phone? Circle One
WARNING - BUII.DING PERIVIIT M[JST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid In full at the time of application beginning January 1.2t?OS.
City of Reaburg's Acceptance of the plan review fee does not constitute plan approval.
2
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~ti`~4"ti~:°, ~'~3I1~~3~(~~;~' ~;~3#° ~,tl ~ ,-'~~~:~~~1(~~1~.~(~~.~~ -~~, tai - ~g~t~.~~i~s~a t~~~t~{ !.i~s~~#~;' si~~ Utz i~,~ #~4r~` ta~~i~
m~i~,It;i~3~,:;
NAME ,Q.rA~-~ t~~~~
PROPERTY ADDRESS ~ ~~c ti ~ v~=~r~ c~ Permit#
SUBDIVISION
.~~~~~~~~c~~
MECHANICAL
~~ ~a~,
Mechanical Contractor's Name: t.1~ii-~ r"~-'-~g `~ ~~Business Name:
Address.. `~~ ~]' City .r ~ _~~ State~~=~ Zips
Contact Phone: ~ ~~~- ~-1 ' ~ Business Phone: (?, Vie-- ~,~~
Email Fax t~~~~~ ~~
Mechanical Estimate S (CommerciaUMnlti Family Only)
FIXTURES & APPLL4IVCES 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
Dryer Vents
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) Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
'i~;i~ it,~r~:~ cif I,ice~~ ~;'i>»ti•~.lci~~r License ~~~~x~~c~~r Date
~Zt.~t~ EI"e:i
The City of Rexburg s permit fee schedule is the same as required by the State of Idaho