HomeMy WebLinkAboutAPPLICATION, BP - 06-00395 - 2428 Robison Dr - MechanicalZ ""
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CITY OF REXB URG * PERMIT #
BUILDING PERMIT APPLICATION Please c ~ ---
19 EMAIN, REXBURG, ID. 83440 If the quest
208-359-3020 X322 06 00395
PARCEL NUMBER;~~~N~~(w 2428 Robison Dr-Cnty Mech
SUBDIVISION; ~ ~ ~ Y tt~' ~~~~n~~ UNI1 ~ tsi.v~.~+~ i.,v i ff
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home ( )
Work ( )
OWNER MAILING ADDRESS: S~Ylei ~ CITY:
o
EMAIL
FAX
Cell ( )
STATE: ZIP:
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: ~ `~'_~,¢,c~(~~i^j 5-~G_S
MAILING ADDRESS: ~~/ ~j ~ ~~~ CITY.
STATE~ZIP ~3 y
PHONE: Home# Work# Cell# 3/J- ///y
EMAIL
FAX
flow many builamgs are located on this property ~
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(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 I have read this application and state that the information herein is correct and I swear that any information which may herea8er 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 2000 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approva w based. Pe if not started within 180 days. Permit void if work stops for 180 days. /
~ ~/ / ~(~
Si nature of n A lica DATE
g pp a
Do you prefer to be contacted y fax, email o honey Circle One
WARNING -BUILDING 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 Rexburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
Please complete the ent~ Application! If the question dot apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required!!! MECHANICAL
Mechanical Contractor's Name: Business Name:
Address City State
Contact Phone: ( )
Email
Business Phone: ( )
Fax
Zip
Mechanical Estimate $ ~~~(Commercial/Multi Family Only)
FIXTURES & APPLL9NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
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.
ign ture of License Contractor License number Date
Required!
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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