HomeMy WebLinkAboutAPPLICATION, BP - 06-00380 - 7357 W 2700 S - New SFR MechanicalZ
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Please complete the entire Application! ie the question does not apply Sli in Nw ~OOr non
applicable
NAME / Qi
PROPERTY ADDRESS 73 S'7 ~/02700 06 00380
SUBDIVISION 7357 W 2700 S- Coun M -
Re cited!!! M tY ech
q ECHA.1~-l ~.,r. , .
J~ /) ,(~
Mechanical Contractor's Name: f~ /`f pJp ~ ~~e.V' ~ P-usiness Name: ~ ~ ~` f~/
Address I ~ '7 (o ~ ~ ~ (~ / ~' City ~d a~~-'0 (- ~ ~ ~ sState_~_Zip S 3 ~ O
Contact Phone: ~p~~7 ~ ~- 8 ~o ~ ~ Business Phone: (RO c~S} S~ %Z' ~ ~o ~ 7
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dw`~ Only)
Furnace Exhaust or Vent Ducts
Z' Furnace/Air Conditioner Combo ~ Dryer Vents
Heat Pump ~ Range Hood Vents
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
_~ Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
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) Gas Oil Coal Fireplace Electric Hydronic
The
schedule is the .came as required by the State of Idaho
Signature of Licensed Contractor License number Date
C"LTI' OF BEXBURG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
PARCEL NUMBER:
PERMIT #
Please complete the entire Application!
If the question does not ~pp#y fill in NA for non spplicabk
We will provide this fox you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER NAME: CONTAC PH~E #
PROPERTY ADDRESS: 3 S-? C~ J ~ .5 cv
PHONE #: Home ( ) 3 ~'~ ~~c^~ Work ( ) 3 Z Z .~ ~ Cell ( )
OWNER MAILING ADDRESS:___ ...)~ CITY: STATE:~ZIP: ~~S~Yp
EMAIL 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
PHONE #: Home
EMAIL F
Work
Cell
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE #: Home ( ) Work ( ) Cell ( )
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property? >~Od.~'
Did you recently purchase this property? ~~'Yes (If yes give owner's name)
Is this a lot split YES (Please bring copy of new legal description of property)
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 sweaz 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 revoke a permit on approval issued under the provisions of the 2003
International Code in cases of any f se statement or misre resentation of fact in the application or on the plans on which the pernuit or approval was
based. Permit void if not started ays. Permit you ~ work stops for 180 days.
Signature of Owner/Applicant D~/~/~
Do you prefer to be contacted by fau, email or phone? Circle CMe
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees ate non-refundable and ate paid in full at the time of application beginning, anuatvl. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application*'k 'k'kBuilding Permits are void if your check does not clear**
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