HomeMy WebLinkAboutAPPLICATIONS - 06-00518 - 4665 S 2000 W - New SFR Mechanicalw.
City of Rexburgl Madisookounty
BUILDING PERMIT APPLICATION 1'leas*; co 060051
19 E MAIN, REXBURG, ID. 83440 i HIA-- gtti >'
208- 359 -3020 X322 4665 S 2000 W -Cnty Mech
PARCEL NUMBER: CDIZ%
SUBDIVISION: UNIT# BLOCK#
(Addressing is based on the information - must be accurate)
—_
I OWNER: `�YP�t1v ,i�1 ��ttCYYI�ICCPv► CONTACT PHONE #
PROPERTY ADDRESS: a(-aU �) �'--> 0 N
PHONE #: Home O 6 3!Ej � � Work OS) - 1 1 � 8 Cell VV j - Z cl 5�,
OWNER MAILING ADDRESS:
EMAIL
CITY:
AX
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
CITY
STATE; ZIP EMAIL
STATE: ZIP:
CITY:
FAX
PHONE #: Home ( ) Work ( ) Cell( )
CONTRACTOR
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work#
STATE ZIP
Cell#
FAX
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, A461ti Family,
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 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.
Signature of 0A r /Applicant DATE f 1 I
Igo you prefer to be contacted by fax, ernail o phon ? Circle One 'JJJ_ J JJJ f
WARNING — BUILDING PE ST BE POSTED ON C L RUC4iON SITE! r ' �
Plan fees are non- refundable and are paid in full at the time of applica on b inning January 1.2005.
City of Rexburg's Acceptance of the plan review fee does not constitul D plan
C1 OF REXBURG 2
r
, lease con Ip ete the ell iql A t)pfi{ ltion ! .tppi tilt ill NA for ltoll
yl1)()1icabIx-
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Req uired. 1 . 1 1
MECHANICAL
Mechanical Contractor's Name: L r, i Business Name: _
Address P O • D _ 7S City gr�c b fn State
_ Zip 9 3"O
Contact Phone: ( 2 - 1 5_0 ^ 770 Business Phone: ( )
Email Fax 351- 9 -77 K
Mechanical Estimate $ (Commercial/Multi Family Only) 10r7
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
_& _ Furnace 0 Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
_ Heat Pump 2 6
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance k5
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
IW Dryer Vents 1
& Range Hood Vents
Cook Stove Vents
Bath Fan Vents 1
other similar vents & ducts:
1 '4 Fuel Gas Pipe Outlets including stubbed in or future outlets t , J
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) as° Oil Coal �Fiireplace
.......... s
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
License mimixr Date
G The City of Rexburg's permit fee schedule is the same as required by the State of Idaho