HomeMy WebLinkAboutAPPLICAITON, BP - 06-00493 - 4500 Cedar Butte Rd - MechanicalZ
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Oc t. 1 2006 10.36AM
9
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
P
Please co
No. 2828 P. 2
�I � 11 � •
19 E MAIN, REXBURG, ID. 83440 if the questio 4500 Cedar Butte -Cnty Mech
208 -359 -3020 X-126
PARCEL NUMBER: & �5o (We will provide this for you)
SUBDIVISION: T^ UNIT# BLOW LOT#
(Addressing is based on the information - must be accurate)
,4u— sv�)
CONTACT PHONE #
PROPERTY ADDRESS: N S _G GC_�Alz &,V G, Z RE= &A- _�b P) 34
PRONE #: Horne (zvg) 3 S -it o l Work (zo8) 4 9 6 -1 gje Cell( )
OWNER MAILING ADDRESS: 1 �14 � 6_ CITY: STATE: ZIP:
RMAIL FAX
APPLICANT (If other than owner}
(Applicant if other than owner, a Statement authOd2 ing applicant to act as agent for owner must accompany dais application.)
APPLICANT WFORMATION: ADDRESS
CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) _ Work (
Cell (
CONTRACTOR
MAILING ADDRESS:
CITY STATE ZIP
PHONE: Home# Work#
Cell#
EMAIL FAX
How many buildings are located on this property ?.
Did you recently purchase this property ?(�? Yes (If yes give owner's name
Is this a lot split ?(SO YES (Please bring copy of new legal description of property)
PROPOSED USE: kDz l - r, o j
(i.e., $We Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under pmahy of perjury, i hereby m* tba t have
read this application and state that the information harem is w reet and I swear tbA any info ion which may hcrea@er be given by me to bearings before the Plying
and Zoning Commission or ft City Couricil for the City of Rexburg shall be tmihfirl and cmcat. I agree to compty with all City regulations and State laws rotating to the
subject manor of this applieatiaa: and hereby authorized representatives of the City to enter upon the above mentiffled property for inaPections Pwpnsea NO TR The
building C ftkil may revoke a permit on approval issued under the pruvisions of the 2003 loternatinnai Code in cam of any false ststtmait or of tbet io
the applicaon on the plans on which the permit m sppmval was h Permit void if not started within 180 days, rcrwit void if work stops for i80 clays.
j 3 06
signature t�erlApplicant DATE
Do you prefer to be cow by fax, email Of phone? Circle One
WARMG — BUILDING 1PERMIT MUST BE posTED ON CONSTRUCTION SITE!
Plan fees are nun - refundable and are paid in fail at the time of application beginning Jain u L 2095 -
City of Rnburg's Acceptance of the plan review fee does not constitute plan approval
Oct. 1 2006 10:37AM
Building Safety Department
City of Rexburg
19 E Main janellhOrexburg. org Phone; 209,3593020 4245
Rexburg, 10 83440 www.rexburg.orc_q Fcw 208- 359.3024
No. 2828 P. 3
4R�
CITY OF
REX
.s
c�
" Ameriwu &mfly c6mm"mr/
�
NAME 4 L-L-is,?-j
PROPERTY ADDRESS q S Ct '%77 Gk
SUBDIVISION
MECHANICAL
Required!
Mechanical Contractor's Name: rR,q,, zTa,J- Business Name:
Address City State A Zip,
Cell Phone: ( ) Business Phone: ( )
Fax: ( )
Mechanical Estimate S /oo� (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Famdy Ihvellirrg Only)
Furnace Exhaust or Vent Duets
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
x Space Heater - GAS
Decorative gas -fired appliance
Incinerator System
Permit# M - -vy-
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Boiler
K Pool Heater \C�)
� x Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Oil Coal Fireplace Electric Hydronic
Mechan Sizing Calculations m ust be submitted with Plain & ABR
Point of Delivery must be shown on plans.
Signature of Licensed CC
The City
schedule is the scone as required by the Nate
Lktwe number Date