HomeMy WebLinkAboutAPPLICATION, BP - 06-00489 - 4176 Homestead St - New SFR MechanicalZ
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City of Rexburg / Madiso tounty
BUILDING PERMIT APPLICA N Please 0600489
19 E MAIN, REXBURG, ID. 83440 li, fh{' =_;ltt 4176 Homestead -Cnty Mech �
208- 359 -3020 X322 ,, AM
PARCEL NUMBER: LPM �ly� , W � WW D (We will proviue uub ivi y V u,
SUBDIVISION: Vk cv\ U NIT# BLOCK # — L — LOT#
(Addressing is based on the information - must be accurate)
CONTACT PHONE # - K--4 - , , S W(ri 1Q5
PROPERTY ADDRESS: HI lU W "L Pcc1 `74 �t�� ' Q K140
PHONE #: Home ( ) Work (:4 Cell W) 7C6Aa
OWNER MAILING ADDRESS: 8490 E , I O N, CITY:R" STATE: _ ZIP:
J
EMAIL ��z�Q_tr,,�c,�.cc��� FAX
APPLICANT (If other than owner) __. N
(Applicant if other than owner, a statement authorizing applicant to
APPLICANT INFORMATION: ADDRESS "
STATE; ZIP EMAIL,
PHONE #: Horne ( ) Work
CITY:
Cell (
FAX
CONTRACTOR: Cx , %N q
MAILING ADDRESS: NA
PHONE: Home# Work# .. Cell#
EMAIL -FAX
How many buildings are located on this property? C
Did you recently purchase this property? No (7f!� (If yes give owner's name) Vo b4,45
Is this a lot split? ( YES (Please bring copy of new legal description of property)
PROPOSED USE: 5 _ja
(i.e., Single Family Residence, Mhlti Family,
agent for owner must accompany this application.)
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 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 approval was based. Permit void if not started within 180 days. Permit void if work
stops for 180 days.
/ ,
SignatUe of Owner /Applicant vAJ J r
Do you prefer to be contacted by fax, entail or one? ,ircle n
WARNING — BUILDING PE ST BE P N b&iSlit id SI )ET
Plan fees are non - refundable and are paid in full at the ti e o a plication beginning Janua I
City of Rexburg's Acceptance of the plan review fee does of co sti
CITY OF E uR
STATE ZIP
2
# kx�isf_" c"onII)Ietc Ole ell s _'� oplicatioti! ff o .�,t +:9� !i�� xl() ��411�ti till €�� NA 1`ilt'
NAME
PROPERTY ADDRESS L4btd 'UJ. Ayll\e� 15 G jj , O -14`1C Permit#
SUBDIVISION �EAec
e u red .1 1 MECHANICAL
Mechanical Contractor's Name: (�e �° Busines Name:
Address 9-00 S EA sr' / s= City c -- 6 r°LL State Z Zip PSL/
Contact Phone: OG a') S� / - 2 b / 7 Business Phone: (
Email
Fax
Mechanical Estimate $ q 000 ' ---c " (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family, Dwelling Only)
-- Furnace -- Exhaust or Vent Ducts
FumacelAir Conditioner Combo f' 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.
a : mo� ,e�
>i �oll(ur'C Ut Contractor
lZ�f�il l�'i:tl r
) /0 `7
LIcaist ntlmb?�r
8 a .s 6 (,�
Date
The City of Rexburg s permit fee schedule is the same as required by the State of Idaho
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