HomeMy WebLinkAboutAPPLICATION - 06-00255 - 2306 E 1000 N - New SFR MechanicalCITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PERMIT # ~~ (~~SS
Please complete the entire Application!
If the que
PARCEL NUMBER: ~POt~ N`-IOL- iSy fro (
SUBDIVISION:
UP
(Addressing is based on the information -must be accurate)
06 00255
2306E 1000 IV- Cnty Mech
OWNER NAME: CONTACT PHONE # ~,?I-~~~S''
PROPERTY ADDRESS: ~ ~b~ ~ %d~o iP/
PHONE #: Home ~~ SSZ-Za3® Work ( ) Cell ~~;) ~Z~~~i~.~
OWNER MAILING ADDRESS: 7zSS ~~/ ~~lsi CITY:~i/.~ ~~/s STATE: I~ ZIP: 83i1D6
EMAIL Si~G~~~'~~i~~' `•cu~FAX
APPLICANT (If other than owner) ~,L
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home
Work
Cell
URG
__--
CONTRACTOR: ~ ~
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? }-~-~
Did you recently purchase this property? No Yes . If yes give owner's name)
Is this a lot split NOS YES (Please bring copy of new legal description of property)
e., Single Family Residence,~Glulti 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 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 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.
~~ S` l 2 ~' l oG
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
**Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
` Please com lete the enh~ A lication! if the
p pp question does not apply fill in NA for non
applicable
NAME ~~~~L~ ~ r ~~
PROPERTY ADDRESS ~3C~6 /-n /~~ ,U Permit# ~~~~-bS-~jZ
SUBDIVISION ~J,¢
Required!!!
MECHANICAL
Mechanical Contractor's Name: 5~~~~ ~O~-'~ Business Name: /U~
Address ~~ ~~ (~,g,,~-l ~,~,c, City~a~ ~~5 State l ~ Zi
p ~3{us6
Contact Phone: (268) ~Z ~-- ~~'6.5~ Business Phone: ( ---)
Email
Fax
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES 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
Z 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) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
License number
The City of Rexburg's permit fee schedule is the same as
Date
the State of Idaho