HomeMy WebLinkAboutAPPLICATION, BP - 06-00368 - 2636 Diamond H Ln - New SFR MechanicalZ
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City of Rexbu~g/ Madiso~'ounty
BUILDING PERMIT APPLICATION l~l~a:~~- ~tj 06 00368
19 E MAIN, REXBURG, ID. 83440 i~,. rf~~ ?s.~~~~=~ 2636 Diamond H Ln-County Mech
20$-359-3020 X322
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: ~ pAt ~~!? ~ ~ ~s ;~~ s i1NIT# BLOCK# - LOT# I
(Addressing is based on the information -must be accurate)
nunvi~A• .~ ~ ~ --r ~ i ; _ I G /_f G~CONTACT PHON ~ ~ -FS//S ~ ~w
PROPERTY ADDRESS:
PHONE #: Home ~~:~) ~~~~ -- ~y ~5 Work ~~ ~; Zl~ - O /~'3 Cell ~?~~S~'`,!~~ `~/~ / ~ ,~_
OWNER MAILING ADDRESS: Tr~. 3~~~-..,, CITY: ~ ` ~.12~ STAB '- ZIP:~O
FAX ~.~ ~~ --,Y//S
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 EMAIL,
PHONE #: Horns
Work ( )
CONTRACTOR: _~
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work#
CITY:
FAX
Cell ( )
CITY STATE ZIP
Cell# -
FAX
How many buildings are located on this property? C~ N
Did you recently purchase this property? No es f yes give owner's name)~~'~ ' ~~-~--~~ ~./~
Is this a lot spli~f ~~~ YES (Please bring copy ew legal description of property)
S, ,.~ (,rL ~ ~~i ~ ~ ~~'S. ~ t'.~ C~,
PROPOSED USE: ~ / e-
(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 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 Ctty of Rexburg shall be truthful and correct I agree to comply with all City regulations and State laws
relating to the subject after of this application and hereby authorized ~sentatives of the City to enter upon the above-mentioned property for inspections purposes.
NOTE: The building fficial may revoke a permit on approval issued he~aovi ~.ZOnn r_ .ama6onal Code in cases of any false statement or
misreprese ion o applicatiop4r on the plans on which thfe(~erMit ~p~~pjval~ss t~ce~'er~it~v of started within 180 days. Permit void if work
stops for
Signature ofiPlwner/App cant ~'"
Cho yotl prefer to be contacted by fax, email c
WARNING - BiJII,DING PE
Plan fees are non-refundable and arE
City of Rezburg's Acceptance of the
? Circle One
~~ 3« ~ ~ ~
DATE
)N SITE!
January 1.2005.
2
~3~~:`:~*~~` 4'.~~~I~~)~3.',~~`• ~~~t' ~'d1~,9..4' .'~~~~~~U~l~~4~~3~ ~t';i,= f~u=_-:+~1l331~~~>a"r~~l.i~,£ils'tal~~~t ~`~.i i",r~-~t,s~~
~i~s~ji;; .,
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
~~~~~
~s-si~ 3~hws ~•~
Mechanical Contractor's Na
MECHANICAL
Address ~ ? ~ , ~°., ~ f~ `I,~., ~ City~•i C~~~~y State ~-~: Zip c~ ~''~ `~ ~?
Contact Phone: (.~3) S ~S ~' Business Phone: ~:'k=`~~ ~ I ~ `? - ~~ 6~~ ~~ ~~
Fax ~~,`~ ~, ~~Y.~' _- ~~•r;~:~,~,
Email .,,._
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelli Only)
Furnace Exhaust or Vent Ducts ~S
Furnace/Air Conditioner Combo ~ Dryer Vents i C~
Heat Pump ~S 1 ~ .Range Hood Vents 5
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance ~~
Incinerator System
Boiler
Pool Heater
!~ ~/ Cook Stove Vents
l r\ Bath Fan Vents ~ ~
other similar vents & ducts:
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets ~~~ ~~
Inlet Pressure (Meter Supply) PSI
Heat Circle all that a 1 ~ Oil Coal Fireplaces F~~ ~~ ~ ~Y ~l
( pp Y)
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
y' ~ ~ l
`~>i~~u~~t~~r~; vf~l.i~;f,~~,~:~1 ~~'ani~•~~;~c~~• Li~en:~e s~~1~r~~~:r Date
~dec~tr~~•~:~~~ _
The City of Rexburg s permit fee schedule is the same as required by the ,State of Idaho