HomeMy WebLinkAboutBP & APPLICATION - 06-00254 - 4356 Juniper Ave - New SFR MechanicalZ
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---CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
06 00254
PARCEL NUMBER:_ P 4 G ~ R1fSo~ 2-0"~"~'o (We
SUBDIVISION: UNITS 4356 Juniper- Cnty Mech
(Addressing is based on the information -must be accurate)
OWNER: s ONTACT PHONE # ~,$ ~ ADS
PROPERTY ADDRESS: ;,~h
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
PLICANT: (If other than owner) L® '~G =
(Applicant tfathe • owner, a ent authorizing applicant to act as agent for er m pany this application.)
APPLICANT INFORMATION: AD° DRF,'S~°-~...,
° ~~ CITY: 5~• ~(l~~ ;~'~
STATE; ~~ ZIP EMAIL ~--•-...._,_.~AX (.Q 2 t-{-1'Z2 3
PHONE #: Home ~ Z - ~ l ' Work ( ) Cell ( ) `~ l ~~~~~
CONTRACTOR:
MAILING ADDRESS: ~ us 3j ~"- CITY ~~` ~- STATE ~ ZIP ~u~,~
PHONE: Home# Work# 2 - ~ Cell# ~j ~ ~-1~2L( ~
EMAIL FAX- ~ 1,{ r 'j Z 2„ '~
Hciw many hnilriinnc arP lnnaterl nn th,c nrn„P,-tv~
v- -- ------- --- ----- r--r--v
Did you recently purchase this property? No ~~If yes give owner's name) ~-(~C~~S .~Y~ m
Is this a lot s lit O YES Please brin co of new le al descri tion of ro ert
p ( g pY g p p p Y)
PROPOSED USE: `~ 'F ~~Adt-mil C~
(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 swear that any information which may hereaRer 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 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 2003 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.
~ r~ f
Signa a 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
PERMIT # (~(p ~Qa 5
Please co~"*'~~*p tIf° Eantir~a A nnlir+s>ttinn 1
If the questio
i-ie~se complete the entire Application! it the q~estioo aces not apply till ig rlA fur noa applicxt-le
NAME ~L~ ~' tAs ,
PROPERTY ADDRESS - L~.Rt ,~ Permit#
SUBDIVISION (,~~Q r ~,
Required!!! MECHANICA~_~ .d Judd
~. ~,t ~r
Mechanical Contractor's Name: ~~ G~ `(l ~ l c~Business Name: `~ ~~~n
Address ~ ~ ~ ~ ~ • ~-~,~ N • City ~ '~'1~ State ~J Zip~~
Contact Phone: (~~:7~j) ((~2~ - (~ Q ~ Business Phone: ( ) ~
Email
Fax fP2~L- ~Z22 3
Mechanical Estimate $ (CommerciaVMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelli 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 ~r~
Heat (Circle all that apply) as ~ Oil Coal ireplac Ele
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The City of Rexburg's
l ~~'
License number
it fee schedule is the same as
Zit-off
Date
the State of Idaho