HomeMy WebLinkAboutAPPLICATION, BP - 06-00490 - 2725 Little Town Dr - New SFR MechanicalZ
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City of Rexburgl MadisoStounty PERMIT #
BUILDING PERMIT APPLICATION Please complete the entire Api,heation,
19 E MAIN, REXBURG, ID. 83440 If O i_� ...
208 -359 -3020 X322
0600490
PARCEL NUMBER:
SUBDIVISION 2725 Little Town Dr -Cnty Mech 7
(Addressing is based on the in ormation - must be accw
OWN ER: �t CONTACT PHONE #
PROPERTY ADDRESS: O O�
PHONE #: Home (�) (o �Co - o v S 'Z Work (z��) %; -t J ? Cell (3,1 - r7fY O
OWNER MAILING ADDRESS: 140t- 1 WJ CITY: X� k ; STATE: LC ZIP: �3q_q
EMAIL
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,
PHONE #: Home (
Cell#
CONTRACTOR
MAILING ADDRESS:
PHONE: Home#
CITY
Work#
EMAIL FAX
How many buildings are located on this property?
64 f yes give owner's name
Did you recently purchase this property? No
Is this a lot split`' N YES (Please bring copy of new legal description of property)
PROPOSED USE:: c 3i CA& a ,, I
(i.e., Single Family Residence, Mi&i Family, Ap
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under penalty of perjury, l 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 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.
NO The building official may revoke a permit on approval, issmd, p►der the provisions of the 2000 International Code in cases of any false statement or
nXgTepresefttion of fact in the applicatioq.erom be plwopwhiClt the permit or approval was based. Permit void if not started within 180 days. Permit void if work
for
DATE
Do you refer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING 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 fee does not constitute plan approval.
STATE ZIP
Work ( ) Cell ( )
CITY:
FAX
2
got :t j ,ly° till at NA for m)a
Please complete tile t'tltt4[' Applica It "t #ta�sltlt'.�ttitl �lts�. i!
NAME ill ic�
PROPERTY ADDRESS Permit#
SUBDIVISION '
e uirett r r
MECHANICAL
Mechanical Contractor's Name: Rex oz fit �Isic r .B��sinessName:
Address (`6, Dad - 75q City tate Zip 83 1
Contact Phone: (,oll ) 3Sd- y 7 Business Phone: ( )
Email
Fax J 5 774(
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
_ Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
gas -fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
other similar vents & ducts:
2 �Urr,aC{, i s b`Cw�
Cook Stove Vents
Bath Fan Vents
— Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) G;) Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
�C _ C.� f f p- z Z 6n�
17, vl'l,i .ris= cI {'i »jioacttii" License niirnDei" Date
i The City of Rexburg s permit fee schedule is the same as required by the State of Idaho