HomeMy WebLinkAboutAPPLICATION, BP - 06-00404 - 5195 W Hwy 33 - MechanicalZ
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AUG-15-2006 TUE 09 53 AM FIRST CALL JEWEL tau Nn t~nQ~~a~~c
Jul, 15. ?0U~ "1,11 YM
' CITYDF'RE~URG ~ 06 404
9 B M~TN, RE~URa, IDC83a ~o p 5195 ~ Hwy 33-Cnty Mech
208-359.3020X322 r,yy
PARCEL NUMSER:~i~IO 1DN~~~~,` _( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOTS`
(Addressing is bQSed on the ifl formation -must be acoarat®)
CONTACT PHONE #~(~-
PROPERTYGA.DDRES~: ~~ / ~ ~ %/ ~ ~~
PHONE #: Homc ~p~ `- Work
OWNER MAILING ADDRESS:
Cell
CITY; STATE: ZIP:
EMAIL FAX
P, 03
ni
b]e
AP~'~G',AN~: (If other than. owner)
(Appticaat if other thaw owner, a statemarr[ authorizing applloant: to act as agent for owner mast accompany this applicatiaB.)
APPLICANT INFORMATION; ADDRESS
CITY:
STATE; ~' EMAIL ~'`~
PHONE #: Tome
CONTRACTOR:
NIAII,ING ADDI
crrsr~~~~~~ ,ST.~T~.~,~zIP~Y v
PHONE: Home# Worl~#~~ ? 77~e11#
EMALI. Fax ~'- 79
tnFtay
are located on this property?
Aid you recently ptucbas~a this property? No Yes (If yes give owner's name)
Ia tlua a lot split`1 NO YES (Please bring copy of neW Legal description ofproparry)
PROPOSED U9E:
(l.e., Siatgle Fsmlly Residence, Matti Fatally, Apartments, Remodol, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGPIATURE, CERTIFTCA~'IOATAN'DAUT~O~~TION: LaderpenaltyafP~+i~SSlketebY~'~+atl
have tCad this applioatiaa and stag ttutr dle itt:lorrmtian hwcin is aotteat and I awcar that any cifatmatian which may laatmBer 6a ~n Dy tae ~ hearings before C16
Planning and ZonlttB Cammiaston ortita City Council for the City of Rexburg sAaQ bd authtLl and revert I agree m comply wig all City ramtlaiieas attd Stan laws
roltnhts to tiro subject taattar of tAia applioatioo anQ hereby euthoriZAA septaseutffi3ves orThe Chy to enLet upon the eDove-mtaUonCd ptoDccry for izespe~tlott9 pntpoaw.
NOTE: The building atFeial may revoke a permit ou appeavel issued wader the provisiaoa of the 2DOt1 Yuuptrriacaaal Codo trt caeca of nay falso stahuGaDt or
mictBpteaeatstlott of t3rr in the a9gll~tion or on the plea on which the yotralt o;; ttpptaval was baaad Pettttit void i£.vAt ~tetad wiQtttt 1 SO drys. Permlt void i4wodl:
stops for 180 day6.
/ /
Si~nattue of Owner/A,pplicant DATE
Do you prefer to be contactod by fax, email or phone? Circle Orie
WAR1NINCr ^ BUII.DING PF.>Q11~IIT MDBT B$ POt37.7CD ON CQl~t9TAUCT.'laQV 3P1~i
Plan tws aim noaro~ndoWe sand era {tsld Ira fbl! at the tlpta oZ aotallct-doa ba~alu9,1 7.3oox
Cily atRslta~'s Accaptanca of the plan ra~tnw fin olort not wosttprt+ plsn xP1P~ _ .
Work ( ) Cell ( )
AUG-15-2006 TUE 09 52 AM FIRST CALL JEWEL
VU I. 17. LUVJ L•LL~iYi
Please complete the ire Application!
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
FAX N0. 12085292793
Tf the que~tiott do~ot apply 1311 in NA for non
Permit
P. 02
Required!!!
MEC~~9IVIC~I..L
Mechanical Contr~a1ctor's Narne: Business Name: i611~
Address ,~/D /l/~/,~bi~> d~'!.~ .~ City ~ State Zip~~~1
Contact Phone: (_ ) ® Business Phone: (~-p~ .5~~~ - 7 7 7 ~
Lmail Fax ~~~- ~ r7 ~3
11~Iech~nical Estimate S (Commercial/Multii Family Only)
FIXTURES & APPZIAN COUNT rao4gi'e Family Dwelling D~ely)
ti Furnace ~ •~~ 5 Exhaust or Vent putts
Furaace/Air Conditioner Combo Dryer Val
Heat Pump
Alt COnClltloIICt
pvaparative Cooler
unit Heater
Space Heater
Decorative gas~fYred appliance
Inci~zerator System
Range Hood Vents
COOK Stove V~AtS
B2t11 ~$Il V 9At5
other sisnilax verb ~ ducts:
Boiler
Pool Heater
Similar fixtures or Appliances
_..._~ Puel Gas Pipe Outlets including slabbed in or future outlets
Islet Presguce (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Mechanical 3fzing Caleutlations must be submtitted with Plans ~ Applfeatioa
Point of Delivery must be. shown on plans.
Signature oF~iaaasod Cona'sc Liconse~~ ~ DetA
Required!
The City of RecburQ's permitfee schedule !s the sanve as required by the Sr~ae of Idaho
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