HomeMy WebLinkAboutBP & APPLICATION - 06-00356 - 2236 S Hwy 191 - New SFR MechanicalZ
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City of Rexbu~g/ Madiso~ounty
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PERMIT # •
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06 00356
PARCEL NUMBER: (w 2236 S Hwy 191-County M ech
SUBDIVISION: UNI'
(Addressing is based on the information -must be accurate)
CONTACT PHONE # ~; ~~ - ~ l3
PROPERTY ADDRESS: % i?5/O ~ ~w S /~ ~ ~'X~~'~
PHONE #: Home ( ) 7.~/~-,~~ j ~;~~,~ Work ( } ~ ~t- - ~ / 3,~ Cell ( ) ~a - 7/ 3~
OWNER MAILING ADDRESS: ~~~~ CITY: STATE: /~ ZIP: ~~
EMAIL ~--~~ .. r__,.. _. 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 #: Horne
CITY:
FAX
Cell ( )
CONTRACTOR: ~ ~ ~`'f"9
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work ( )
_~._
`-a~sr~ n `~~s
- ~1~~~,,~s ~ ~~~ CITY
Work# ~ ~ ~C->>- ~Cell#
FAX 3~~ - ~ ~
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?~T~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ~E~i~~z - ,~~rLt'r'iC.t- ~~ir~
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, G
Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that 1
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 revo a permit on approval issued under the provisions of the 2000 Intematioruil Code in cases of any false statement or
misrepresentation of fait in the applicat~n 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 I80 days. ~
Si 'o Owner Ap 'cant DATE
Uo yolx pI•c~l'er to, e col eted by fa;c, email o Zo Circle One
1 ARMING - BUILDING PE ST BE POSTED ON CONSTRUCTION SITE!
(fees are non-refundable and are paid in full at the time of application beginning January 1.2005.
City of Resburg's Aceeptance of the plan review fee does not constitute plan approval.
EMAIL
-S STATES ~ ZIP ~~ ~~~
2
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i'~ts~.,tA c`agrt~~tityt. i#tca t~~~t~t°~ a~.it~~~~~;~t~~t~.~t? rt~ ~~,~, ~
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NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
.~i~`t~+~ It ~'1`'~C', ` I
MECHANICAL
~'Yl\y r~C'~~ ~~l
Mechanical Contractor's Name ~ ~,'`~ Business Name: rh.?'7~, fl~,~/~-~...~ ~~
Address ~~^~ s . ~/f~ws ~~c~ ~i y( City ,_ ,,_ ~D~ ~S State ~~ Zip 7~s o
Contact Phone: (~ 3 5~'Oa K` Business Phone: {
Email
Fax ~ 5 ~~'3S ~`
Mechanical Estimate S (CommerciaUMulti Family Only)
FIXTURES & APPLL4NCES 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
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) ~ Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
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Date
The Crty of Rexburg s permit fee schedule is the same as required by the State of Idaho