HomeMy WebLinkAboutBP & APPLICATION - 06-00292 - 1723 W 5350 S - New SFR MechanicalZ
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City of Rexburg/ Madiso~'ounty
BUIL.DII~1G PERMIT APPLICATION ~rl~;sl;ti` ~ 06 00292
19 E MAIN, REXBURG, ID. 83440 ~ ~ ~~~~~ ~~g~A`_
208-359-3020 X322 _ 1723 W 5350 S-Casty Mech
PARCEL NUMBER:~~II~D~V ~ ' ~UNIT# r BLOCK#v~~ ~ LOT#
SUBDIVISION:
(Addressing is based on the information -must be accurate)
PROPERTY ADDRESS:
J
PHONE #: Home ( )~~~y/~~ Work ( ) 7~j' ~-yds Z- Cell ( )
OWNER MAILING ADDRESS: ~f ~L ~ aS~/~ °h- CITY: ~IUSTATE: Z~ZIP: 8'~'~'~- ~
EMAIL FAX
APPLICANT: {If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner mast accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP,
PHONE #: Home
CONTACT PHONE #
CITY:
EMAIL FAX
Work ( ) Cell
CONTRACTOR: ~fL- ~ L(~ ~ ~ ~ ~--5
MAILING ADDRESS: ~~ ~~ ~ z ~d yt~ CITY , ', STATEZIP 8~Y z-
PHONE: Home# ~~,~ •-~f'VVork# ~~''~'-r~~~ Cell#
EMAIL
FAX
How many buildings are located on this property?
Did you recently purchase this property? ~T Yes (If yes give owner's name;
Is this a lot split? ~TOj YES (Please bring copy of new legal description of property)
PROPOSED USEII://
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I
have read this application and state that the information herein is comet and I swear that any inforn-ation 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 repnsattatives 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 Ute plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work
stops for~18,0 days.
Signature of Owner/Applicant DATE
1)o you prei~er to be contacted by fa;c, entail or phone? Circle One
WARNING - BUII.DING 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 Reaburg's Acceptance of the plan review fee does not constitute plan approval.
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~~~t`2!^~,~ t"+.i 114~)~#~Ct~ ~~$ ~'tl~° _~~3~41;~l1;~t~it~ ~~'f~+~ ~~dat~~:ti,zt ct: ,st _t}41~~.v 9~1! Uzi i~_~ try[- €i¢at[
z~;igsl+~:<~;
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION ~;,~ T~ ~~/d. v I~ ~- /~~„~. son--
~`~,~r~r~~cl ~
MECHANICAL
Mechanical Contractor's Name: r/~. ~ ~ ~ Business Name: L ~ ~ -~ % ~~
Address ~ ~ ~ y' ~~ Q,~'B~ ~ City ~' ~. Q n ~~ ~ ~ Y State L 6~ Zip ~ 3 ~' ~s~
Contact Phone: ( ) C ~ -- ,i y t / Business Phone: ( )
Email Fax
Mechanical Estimate S (CommerciaUMnlti Family Only)
FIXTURES & APPLL~NCES COUNT (Single Family Dwelling Only)
Furnace ~_ Exhaust or Vent Ducts
Furnace/Air Conditioner Combo ~_ Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
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
other similar vents & ducts:
~, SC.,~. 4 ~~ ~ ~ ~ fix:>~x~'~~-'
~, ~~- `~
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~?}t~rliS~~.il'^ t)t ~.1ti+911tS+"C~ ~~,t7311'.lCtC1T ~:1C~~1tS% tUll'I1bF2C
~{1';.~il lt'y~t1?
Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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