HomeMy WebLinkAboutBP & APPLICATION - 06-00369 - 5458 S 5700 W - New SFR MechanicalZ
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City of Rexburg/ Madiso~'ounty PERMIT # •
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
SUBDIVISION:
(Addressing is based on the information - ~
Please complete the entire Application.
If the questi - "", . ,.T . r---- --°-- °----t;^.,hlo
(wf 06 00369
uNlz 5458 S 5700 W-County Mech
nust be accurate)
OWNER: ~~ 1/e ~,~$~ CONTACT PHONE # ~/~'~- g3~ ~-
PROPERTY ADDRESS: ~S~? S~,c,`~'r S '70 0
PHONE #: Home ( ) Work ( ) Cell ~~~ ~'3~~-~30 ~
OWNER MAILING ADDRESS: °~ ~~ L~~t~-r•~ /~A-CITY: K~Pk ~;~°~ STATE: ~~ ZIP: ~3 y`~~
EMAIL<ve-~ o ~s~-- ~ ~a.~/ FAX ~~
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
CITY:
STATE; ZIP EMAIL
FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR: ~~` ~s a,~ rv-~-
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? ~
Did you recently purchase this propert No es (If yes give owner's name)
Is this a lot split. N0 YES (Pleas bring copy of new legal description of property)
PROPOSED USE: ~%-~ ~ f~
(i.e., Single Family Residence, Multt an
~ti
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of perjnry, 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 heazings 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
misrepres tats of fact ' t pplication 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 80 da s.
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 STTE!
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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Pease complete the ent~ Apphcatlon! 1f the question dot apply fill in NA for non
applicable
NAME ~v~ ~ ~~-.
PROPERTY ADDRESS s~f~ S• ~rJco c Permit#
SUBDIVISION
Required!!!
1VIECHANICA~
Mechanical Contractor's Name: IJr~,~~' ~~~r Business Name: a ~' ~
Address y~ ~ ~ ~12, ~ -~ City ~ ,, r State Z ~ . Zip 3 ;,~ z
Contact Phone: (k~) ~' ~,2, -3'3 7Z Business Phone: (2.®~) s°a ~' 3 ;3 `7~
Email e o Nary E~} VA ~ ~ ~e„~l~ : ~.c:. -..~ +- Fax ,~,o ~ - t2 g _ Z 11 f
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
_~ Furnace ~j~j ~ ~ j Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Z Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
~. Decorative gas-fired appliance 'jj0
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances ~j t ~"~
Z Dryer Vents ~jtrj
~ Range Hood Vents ~j
Cook Stove Vents
~~ Bath Fan Vents 2~
other similar vents & ducts:
~'~5S
rnec~~~
~_ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Ga 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 ate
Required!
The Ciry of Rexburg's permit fee schedule is the same as required by the State. of Idaho
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