Loading...
HomeMy WebLinkAboutAPPLICATION - 06-00485 - 2834 Diamond H Ln - New SFR MechanicalCity of Rexburgl MadisoW ounty BUILDING PERMIT APPLICATION PICAS 0600485 19 E MAIN, REXBURG ID. 83440 ' tiv , 2834 Diamond H Ln -Cnty Mech bl 208 - 359 -3020 X322 PARCEL NUMBER: c5n1..('i `�OyGJo (We will provide this for you) SUBDIVISION: EgkSS UNIT# BLOCK# - 3 LOT # __b (Addressing is based on the information - must be accurate) CONTACT PHONE # PROPERTY ADDRESS: LANG P)3 44D PHONE #: Home ('aE3) x Work (2o . Y o F!A Co ; r Cell (lob 3 0 - OWNER MAILING ADDRESS: - 71 0 `�) fib Uu5 t CITY: _STATE ZIP: � ! EMAIL &,0SR'.LQKM (Ofr Z �( . O_ 625 Jb( -- 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 STATE; ZIP EMAIL FAX PHONE #: Home ( ) Work ( ) Cell ( CONTRACTOR CITY: MAILING ADDRESS: 331 to - bw CITY l - Y-w STATE ai zip93 '140 PHONE:` Holm^ e_ i - 1 13`1Work# Cell# � - t EMAIL ©`II U 1 M (b ►' FAX 2 5 ft (6 How many buildings are located on this property? tIMNE Did you recently purchase this property? No (&(If yes give owner's name) _'t&tA5 (Ak LM� Is this a lot split? NO YES (Please bring copy of new legal description of property) PROPOSED USE: �in�11 -P41 1 4 ��S`�ZYIGl (i.e., Single Family Residence, 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 hereafter be given by me in hearings before the Planning an Commission or the Co'" ncr a City of Rexburg shall be truthful and cooed. I agree to comply with all City regulations and State laws reiatm the subject ter of this aP cati hereby uthorized representatives of the City to enter upon the above- mentioned property for inspections purposes. NO The building offi may re ke a icon app al issued under the provisions of the 2000 International Code in cases of any false statement or misre resentation of fact in t appli lion or on a plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops r 180 days. Signature SFAwaerAp 2_1 Zcc( DATE Do you prefer to be contact d' fax, ern Il or phone? Circle One W BB 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 he does not constitute plan approval. 2 ��1'ase tYo iple the 4'fl� '� l��titt �t :tti t� � +. #f�� a��t�; #id3ei €l s tai ; �s���v' i'�ii i z :� f01 11011 N AME � r PROPERTY ADDRESS N31 `Jif�mon,D Permit# SUBDIVISION `SPTW\G CZ60t equine r 1 MECHANICAL Mechanical Contractor's Name: Business Name: To4n�,,-4 4e4r U.c Address fo y a w ,1i� uh� 4 r ; c City �- �-'�'Z7 State � Zip Contact Phone: Business Phone: (2,46) Email Fax Z 35Z - Mechanical Estimate $ (Commercial/Multi Family Only) =71RES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace /Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater I Decorative gas -fired appliance Incinerator System Boiler Pool Heater Dryer Vents Range Hood Vents Cook Stove Vents 3 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 j Electric �y _f Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. r, :�,igtai�u;w ufi : S;ei�.,vc� f't»3tractor Recd d it'!�c�? 132-7 Liwensc numbe -t 2 � , =067 Date I The City of Rexburg's permit fee schedule is the same as required by the State of Idaho