HomeMy WebLinkAboutBP & APPLICATION - 06-00283 - 52 S Hidden Valley Rd - Mechanicalz
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CITY OF KEXB UKG
BUILDING PERMIT APPLICATION Please c
19 E MAIN, REXBURG, ID. 83440 If the questi
208-359-3020 X326
PARCEL NUMBER: ~~~' ~,J V ~1 ~.'11~ ~ U (We
SUBDIVISION: UNI1,T
PERMIT #
06 00283
52 S Hidden Valley-Mechanical
1TT .~ i ~ ,
is based on the tntormaaon -must be accurate
OWNER NAME: Ctlly CnH~e~ CON~T/ACT PHONE # ~~/(o °~yot
PROPERTY ADDRESS: 5 ~ Sc+~~'FGt ~1~~Q~P~,~ (~a lfey l~
PHONE #: Home ( ) ~C~sZ Work ( ) Cell ( )
OWNER MAILING ADDRESS: 5~.~. CITY: STATE:b~Y ZIP: ~~ld
EMAIL FAX
APPLICANT (If other than owner) / ~ L'e'._
(Applicant if other than owner, a statement authorizing applicant to act as agent fox~o~wner m~u/st accompany this application.)
APPLICANT INFORMATION: `~ADDRESSt~iU~ ~~ia~~.v (/r~`~~~Ct`• CITY: ~~ tt`'<
STATE; ~p ZIP d C~ EMAIL FAX
PHONE #: Home ( ) ~~~"/,7~7 Work ( ) Cell ( ) 7yS -l'7~7
CONTRACTOR:
MAILING ADDRESS:_ f~~ 3 ~ / 8 60 ~. CITY ~ STATE,~_ZIP,
PHONE: Home#~o2`7 ~~~ Work# Cell# ~/~ Yb'4 ~!' Fax#
EMAIL Jrr~~~i'~l~Fr-al.~(.~v:x IDAHO REGISTRATION # & EXPIRATION DA
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? NO 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 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 e a pemut on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact
in the application r son which e permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner]~pplicant t2 ~ nn
Do you prefer to be contacted by fax, email or phone? Circle One (C v
WARNING -BUILDING PERMIT MUST BE POSTED ON C UCTION SITE!
Plan fees are non-refundable and are paid in full at the time of applica inning„ anuaty L 2005.
City of Rexburg's Acceptance of the plan review fee does not c ti a pl rev
'Building Permit Fees are due at time of application'k* 'k*Building Permits a voi if your check~oes-not cle
CITY OF REXBURG 2
~'3%ff~;
Please complete the ent~ Application! If the question d~d~ot apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: 1Lkrn.ys; Qc~ v-..e..~~r-~ Business Name: ~ yPrpC/~ ~-a ~r~'1.e~:^c ~i~~
v
Address ~`> 3 /~J ,. /8'/O ~ ~ City,~~,r~n ~ State .1'~d~ Zip ~13,~y~
Contact Phone: ( ) ~f ~ `f ~G 'ti' Business Phone: ( )
Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
l Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on clans.
,.~ r~ ~ ~~~ ~ ~G
Rtq d2 Signature of lic«iaed contractor Licrnse number Date
The City of Kexburg'.r hermit fee schedule is the .came as required by the State of Idaho
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