HomeMy WebLinkAboutAPPLICATION, BP - 06-00526 - 2461 Little Town Dr - New SFR MechanicalZ
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City of Rexburg/ Madison ounty "T-"L
BUILDING PERMIT APPLICATION P 1 mig
19 E MAIN, REXBURG, ID. 83440 i i r i n i' , a 0600526
208- 359 -3020 X322 2461 Little Town Dr -Cnty Mech
PARCEL NUMBER: - 0 T
SUBDIVISION: LlJ 1 tt w
(Addressing is based on the information - must be accurate)
CONTACT PHONE # 17 - Co 7cSK
PROPERTY ADDRESS: aoc. I /-Of S u
PHONE #: Home Work( ) 317- 4?7,33 ` C 11( }
OWNER MAILING ADDRESS: 1 /( A i-i i(f o o CITY: iZC� ,tr STATE: Z6�Z IP:
�F
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,
CITY:
EMAIL FAX
PHONE #: Home ( ) Work (
Cell (
CONTRACTOR: & f 3&7
MAILING ADDRESS: �'U- 00 a�/- 7 CITY 1 STATE
PHONE: Home# Work# 317- Cell#
EMAIL FAX GzS(e `-O (ab z
How many buildings are located on this property?
Did you recently purchase this property? No 66:s of yes give owner's name)
7
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: 1 , h L I
(i.e., Single Family Residence,`Multi Family,
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
stop fo ^� r 180 days.
Signature of Owner /Applicant DATE
Do you prefer to be contacted by fax, entail 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 he does not constitute plan approval.
ZIP
2
couipft- t. f ii' t'ii!ffc A [)p1l('a fi-ar I:t .i L gII l ust 41 +. !<> ii[A App! III i` A #+,v liol
Alp
NAME [ � N
PROPERTY ADDRESS t_ 3O b kx I Permit#
SUBDIVISION 't e r
Requ e . ! ! MECHANICAL
Mechanical Contractor's Name: �e I B�essName
Address City ,, State 1_�� Zip 53W
Contact Phone: ( ) 3S6 1770 Business Phon . )
Email
Fax
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo Dryer Vents 6 rr
Heat Pump In Range Hood Vents J
r Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents i,
Unit Heater other similar vents & ducts:
Space Heater
_ Decorative gas -fired appliance 5?
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets 't�
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplac Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
3' as ldt.11' Ot f ?t; ;i3S'fl Li+' r-ils;; D iflbn Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho