HomeMy WebLinkAboutAPPLICATION, BP - 06-00208 - 1723 W 5350 S - New SFR MechanicalZ
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City of Rexburg/ Madiso ounty
BUILDING PERMIT APPLICATION 1'i~=~t OG 00208
19 E MAIN, REXBURG, m. s3aao ~~~ ~~''~ 1723 W 5350 S-Cnty Mech tt#~1~~
208-359-3020 X322
` PARCEL NUMBER:~~ ~~~~ ~ ~~ ~ ..., ..~~~ Y~...~u~ ~u~ ~.,~ y~u~
SUBDIVISION: _~~~ ~ ~~ UNIT# BLOCK# ~ LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: ~~o~~~
PHONE #: Home ( ) ~~~s~ ~- ~d ~~Work
~' Cell ( ) ~~
OWNER MAILING ADDRESS: ~~ ~r ~ ~-~~~ ~--~ CITY:.~,T_T_STATE: z'~ ZIP:~.~~'3`'~
EMAIL
APPLICANT: {If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner meat accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL,
PHONE #: Horne
Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home#
FAX
CITY
Work#
CITY:
FAX
Cell#
STATE ZIP
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property?(1~1~ ~~~f yes give owner's name) f/ ~ ~v ~/~.~.
Is this a lot split? 1~~ 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 t
have read this application and state that the information herein is corr~t 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
rotating to the subject matter of this application and heroby 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 llA t u
rho you preler to be contacted by faY, 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 1.2t?t7S.
City of Reaburg's Acceptance of the plan review fee does not constitute plan approval.
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~~~~:~~~~;~:° ~;~~r~~~~t;tt. #~i~~a ~~r~t, ~~ ,~'~..t.tl~t;ztl~t~rt
~~~~i~9~~.s~~~, .
NAME
PRC~PERTY ADDRESS
,. SUBDIVISION '~~~Sc~~n
06 00208
1723 W 5350 S-Cnty Mech
1~~~~~~°~cl r
MECHANICAL
Mechanical Contractor's Name: cJ <~ ~~ G /l Business Name: ~~~~/
Address ~"„ ,,, ~''~.,,Y ~.,~.~ City State Zip
Contact Phone: ( ) /: ~ - ~ ~ ~/ Business Phone: ( ) ~ x~~l ~` G~
Email Fax ~~~:~ `~ _ 1 ~~`~
Mechanical Estimate $ (CommerciaUMnlti Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
v Furnace ~_ Exhaust or Vent Ducts
~_ Furnace/Air Conditioner Combo ~_ Dryer Vents
Heat Pump ~_ Range Hood Vents
~ Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
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.
:`il~yllil~lil'~.. [7 ~~~.IL'i;9d:ie~C.~ ~~~(5111Ti1C~(7l" ~a~J~ti11S% 111I111bL'C
Date
The City of Rexburg s permit fee schedule is the same as required by the State of Idaho
04/18/2006 09:06 2084584076 PAYS RACING LLC PAGE 01
-May. 2, 2006 11:52AN~ • • No.20~5 P, 1
i~~~:~se c;c~rra~l~f~ the ~tttir~ ~ppii~a#io~.~ .
;~ps~a~c~~~ 0~ 00208 .. .
N~.ME
PROPER AnA~ss ~ 1723 V!f 53v0 S-Cnt Mech
y
SUBIaS~YSIpN _~;~)~,Y ,~77Y1
,~e~~~~~c~~1 ~ ~:~EC~~~N~CA~
Mexh2mical Contractor's i\1ame:.~(,~ >! ~ ~ -Business Aiame: ~~~~~
Address ,S' ~'~_,.~ ~.~-> City State ~ Zip
Contact Phone: ( ). % :-~ ~- ,~ ~ ~~` Bus3aesa Fhops: ( ) z. ~ ~ „~ ~ l'~
Fina~i1 Fax t.,C~~ ~ -1 ~~~ r,
Mechanical Estimate S (CommerdallMulti 1~'®umt~y Ong)
71RE.S d~ A,~,PZJANC„FS C+OITNT (~5'i~gle ,Fm~y Awedii~ 4-~1Y)
_ ~-' F,irnace - ~„~,,,_, Fachnust or vent mats
~,,,,~ Furnace/Air Conditioner Coin'bo _~ Dryer Vents
I~eaC Ptunp ~~ RRnge Food vents
~ Air Conditioner - Cook Stove Vents
Evapoxative Cooler Sato Fan Vents
Unit Heater other similar vents & ducts:
Space Hestex
Dece~rative gas-find appliance
incane~torr System
Boner
Pont Heater
Simalac fi:+ciuree oz Appliances
;~ Fue1 Cfas Pipe Outlets including stubbed in or futwe outlets ,
Inlet ~essure (Meter Supply) PSI
Heat (Circle all that apply) C}as Oil Coal Fireplace Btectric
Meebanical Sizing Calcnlntions must be submitted with Plans & Application
Paint of Delivery mast be shown on plaAS.
~~ 2~~
' Si~n~3FUrc u}- I.iLrn~L'C~ ~Q31ttflCtOT f.1C0119C f1 IriOCI' DHtC
Rcyu~red',
The Ci o~'Rexbur~'s p~nit fiea ,~cha~'crle !s the aa~& as required by the State of Idaho
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