HomeMy WebLinkAboutAPPLICATION - 06-00569 - 1848 W 4200 N - New SFR MechanicalCity of Rexburgl Madisowounty P] • 00569
BUILDING PERMIT APPLICATION Please; coull 06
19 E MAIN, REXBURG, ID. 83440 it' 1:114� clot - :4Jl+ l 84g W 4200 N -Cnty Mech
208 -359 -3020 X322
PARCEL NUMBER: '' �� '( We wiii yiuviuc uus >or you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
CONTACT PHONE #_2N 35(o- 37-W
PROPERTY ADDRESS: IS 4% W 4 2 - 00 �A REY B 0RI G - 1D <3 3 q qO
PHONE #: Home (4V (o64 - JS (v(y 3 Work ( } Cell ( )
OWNER MAILING ADDRESS: 43(A &I ZQ'�0 _ CITY: FE)XBQ STATE:�ZIP: 83T 40
EMAIL h P d & 1 dQ , hey FAX 3 & - 790-7
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 ( ) Work ( ) Cell (
CONTRACTOR: E t_ F
MAILING ADDRESS: 43(oq N 20ffi W CITY RF1(B R STATE Q_ ZIP '93 LI46
c�
PHONE: Home# 20$ 3c;( -'� 2 2 Work# — Cell# —
EMAIL Q jda , n &I FAX ? 56 - 796 - 7 _
How many buildings are located on this property?
Did you recently purchase this property? No Yes If yes give owner's name) DOR 4 A R 1 _
Is this a lot split? NO (� (Please bring copy of new legal description of property)
PROPOSED USE: SiMG f=AM IL IZESI DENLE
(i.e., Single Family Residence, Multi Family, Apartments, 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.
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
stopkfor 180 days.
1— W ( /�1C c' 2/�� /
Signature of Owner/Applicant DATE
Do you prefer to be contacted by fax, entail or hon Circle One
WARNING — BUILDING PE ST 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.
CITY:
FAX
FA
' ': stl 4- ol]iplete 01c, V101 , _ pp it;sltioll' 'if fill, -, d ioit .ippt till fill JNA 101 11041
'Ippliv abh"
NAME C�� PAKIELE _ hjjQE
PROPERTY ADDRESS !j 20 W Y 206 N FE X IW2 6 St Permit#
SUBDIVISION M A
Required !!.
MECHANICAL
Mechanical Contractor's Name: EReD 5 L A j g — Business Name: t7E516A REATI NG
Address i NtJOVE
�j 1 E A ����, City T��F�}LIS State Zip
Contact Phone: ( ) Business Phone: (2pg) S2 1 5 –!R'3
Email Fax,
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
_ Furnace /Air Conditioner Combo �_ Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
j Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
other similar vents & ducts:
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
PpO ANE
Mee gnial Sizing Calculations must be submitted with Plans & Application
) (-"\ Point of Delivery must be shown on plans.
i o yl
mw n- t)] ],1t: 116s_CI Contracior
yS9
License miniber
I_ Range Hood Vents
Cook Stove Vents
_ Bath Fan Vents
/0_ /S_C�)6
Date
1 The City of Rexburg's permit fee schedule is the same as required by the State of Idaho