HomeMy WebLinkAboutAPPLICATION, BP - 06-00428 - 5515 N 4000 W - New SFR MechanicalZ
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City of Rexbu~g/ Madis~'ounty
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PERMIT #
ii t7~~, ~l~t~;>~;i ias€t
06 00428
PARCEL NUMBER:>~~~~ N ~ F~!~( We ~ 5 515 N 4000 W-Cnty Mech
SUBDIVISION: UNIT#
(Addressing is based on the information -must be accurate)
OWNER: ~"~ . ~ CONTACT PHONE #
~:
PROPERTY ADDRESS: ~ > ~ '~ ,~`` ?r- ~ `~
PHONE #: Home ( ) ~ ~ ~-~ Work
OWNER MAILING ADDRESS:
EMAIL ~"~ ;
,~
FAX
~" Cell ( ) ~"
CITY: STATE: x~
ZIP:
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 FAX
PHONE #: Horne ( ) Work ( ) Cell ( )
CONTRACTOR: ~~ -`
MAILING ADDRESS: ` ~"~. _~'` CITY
PHONE: Home#
EMAIL
Work#
FAX
CITY:
Cell#
STATE
ZIP
How many buildings are located on this property? ;°7
Did you recently purchase this property? No es If yes give owner's name) ~~ `~~~~'
Is this a lot split? O YES (Please bring copy of new legal description of property)
PROPOSED USE: ~ ~ ~:~ '~ ~` ~~ ,rv .~ !;, rx`'.. ~ . r.
{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 City of Rexburg shall be truthful and twrrect. 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 far 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 approval was based. Permit void if not started within 180 days. Permit void if work
stops for 180 cjags~" ,,~ ,
:r,;. ,.
Signe of Owner/Applicant
Do yoll prefer to be contacted by faY, email or~1`? Circle 0i~e'
WARNING -BUILDING PERMIT MUST BE P03TED
Plan fees are non-refundable and sre paid in full at the time of a
City of Reaburg's Acceptance of the plan review fee does not coy
~~ $~o~ ~IT~I06 I vJ
ttio beginning Janua 1 2005.
top n
0l~ 0~ REXBURG 2
~~~~~;~°~~; t~t~tt~(ji~~t*, f~ttt', ctrl. ~~t)a~i~;~~l~a~att
t~~~l~ a ~~1~:
NAME
PROPERTY ADDRESS
SUBDIVISION
1~°tft~ i~,.,,tit3,9 ~ias~tct ~~~~o~s' till gig ~'~.~ t~~:r~' ~!c)i~
Permit#
.~,~~~~~~uc r r
MECHANICAL
Mechanical Contractor's Name: z_.,. ` t ~~ P~~o~ Business Name: C (/
Address LI /7F S • Pro,~'e~J/c~ y / Way ~~ ~ City ~GuZ ~ ~ l~ State_~ Zip 310 `~
Contact Phone: (Z{j~} ,~~ S~i"`7otG.~ Business Phone: ( ) ~~-.
Email ~ /4 ~ Fax /~~.
Mechanical Estimate S (CommerciaUMnlti Family Only)
FIXTURES & APPLIANCES COiT1VT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo _(_ Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
~.. Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Range Hood Vents
Cook Stove Vents
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 apply) Gas Oil Coal Fireplace.,,Electric.
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
°~;iv~~a~i~~~r:~ ~rt'7.i~:ri~ls:~d C't»~iract~~r hic~2178e ~1ut~~he~- L~ ~ ~nDate
T e City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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