HomeMy WebLinkAboutAPPLICATION, BP - 06-00442 - 521 Angela Dr - MechanicalZ
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Sep 05 06 03:31p p.2
1!c ~1a r. 4. ~ ~ Q ~ 2 : 4 I P'vi ~ ~ Arlo. ~ a
J495 .. 2
CITY OF REXB URG PERIvIIT tt
BUII.DING PERwIIT APPLICATION
19 E MAIN. REXBURG, ID. 8340 Please 06 00442
208-X59-30?0 X326 If the ques
nn 521 Angela Dr-Furnace Replacement
PARCEL NUMBER:1'~~R-~-1/JS~~O~ ~~ (~
SUBDIVISION: UNTfT BLOCK LOT#
OWNER VL~Ir•~.e.~Q , ~~55 CONTACT PHONE
PROPERTY ADDRESS: ~J21 ` x .-~
PHONE ~: Home (~J) `j~j C -- ~y$ L Work ( } Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
APPLICAttIT (If other than. owner)
(If eIIplicsn+. if ether than owner; a statement authonztng sopiicant to act as agent for owner must accompsry this applicadon.)
IvLAILING ADDRESS OF APPLICANT
CITY: STATE; ZIP
PHONE ~: Home ( ) Work ( ) CeII ( )
CONTRA,CTOR:~(~~ ~~~__PNONE: Homed WorkT Ce11T
MAILING ADDRESS: `~1,~ U?, 1~~ ~;r_~-~ CITY ~ STATE~ZiP_~Z~
How many houses are located on this property?
Did you recently purchase this properly? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of propettyy)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Aparnnents, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION A~1D AUTrIORIZATION; tinder penalty of perjury, 1 hereby
certify that ! havc read this application and state that the informstion hercin is correct and I swear Nat arty information which say
hercaP,er be given by tnc in hearings befort: G'te Planning and Zoning Commission or the City Council for the City ofR,xbnrg shall be
truthful and correct I agree to comply with all Ciry regulations and State laws relating to the subiecl :Hater of Ibis application and
hereby authorized representatives of the Ciry to enter upon the above-mentioned property for inspections proposes. NOTE: The
building ot~ciel tttay revoke a perrlit on approval issued under Ne arovisions of the 2000 International Code in cases of any false
statement or misrepresentation of fact in Ne application or on the plans on which the perL-tit or approval was based. Permit void if not
started within 130 days. Permit void if work stops for 1 SO days.
Signature of Owner/Applicant
! /
DATE
WAIiN]:NG - Bi1CLDIlYG YERM)<I' :MUST BE PASTED ON CONSTRUCTION SITE!
Plan fees are noa-relltndable gad are paid in fhll ai the lime of appllgtlon beginaing lanuarv 1.2003.
City of Rexbarg's Acceptsoce of the plan review fee doe9 not constitute ptan approval
'`"BuiIdiag PeC7Alt Fees are dne at lime of application'''
"tBuilding Permits arc void if you check does not clear""
Sep 05 06 03:31p
Feo. $. 20ub 1:58P~41 ! • Nc, 1624 P. ~
Please complete the entire Application! if t>zE question noes nuc apply fill in xA for non
applicable
NAME ~./~ , c ~. uLQ x ~-~, ~
~" PROPERTY ADDRESS X21 1Arv.~.c.Q~. Permit#
SUBDIVISION
p.3
.IZequired!11
11~~C~~AN~~14.~
Mechanical Contractor's Name: l',I1 UILI ~l ~nc~ Business Name:
Address d-~~ -t,C~,~l ~~~h ~k City State Zip,
Contact Phone: {2~ 1 522. 3~`Z Business Phone:
Email
il~lecitanical Estimate $ (Commercial/Malti Family Oiely)
FIX"1'UXES ~ A.PPLIANCES COUNT (Single Family D-velling Only)
)( Furnace - Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vests
.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 a]I that apply) Gas OiJ Coal Fireplace Electric
Mechanical SiziQg Calculations must be submitted with Plans & Application
Point of delivery mast be shown on plans.
G~z'z~v~~ NVG~ (~-f~[~- 5 ~G
Si®oature of Licensed Contractor License number Date
77te Ciry of Rexburg s permit fee schedule is the .came as required by the Slate ojldaho