HomeMy WebLinkAboutAPPLICATIONS - 06-00629 - 4614 Juniper Ave - New SFR MechanicalCity of Rexburgl Madiso *ounty P
BUILDING PERMIT APPLICATION 06 00629
19 E MAIN, REXBURG, ID. 83440 I :' t i i
208- 359 -3020 X322 4614 Juniper -Cnty Mech
PARCEL NUMBER �' s W, (We N
SUBDIVISION: BLOCK# - !�7 _ LOT # `ff)
(Addressing is based on the information - must be accurate)
OWNER: yy es yctrx,r7S6-)
PROPERTY ADDRESS: /� A
PHONE #: Home ( ) (V� (o - 0350 Work
CONTACT PHONE #
) 35(o - H Lf IS Cell( ) j (oct ._ Z 1 2 0
OWNER MAILING ADDRESS: Co lo EC,t�lew i ITY: e7 -lDLq STATE:ZIP: g3`/ `'l (�
EMAIL FAX
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 FAX
PHONE #: Home ( ) Work( ) )
CONTRACTOR
MAILING ADDRESS: CITY
PHONE: Home#
Work#
Cell#
EMAIL 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? 100 YES (Please bring copy of new legal description of property)
PROPOSED USE: S Ir
(i.e., Single Family Residence,
Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under penalty of perjury, l 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 pla, h the permit or approval was based. Permit void if not started within 180 days. Permit void if work
stops for 180 days.
Signature of Owner /Applicant DATE
Igo you prefer 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 Januarp 1. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval.
STATE ZIP
2
ui•.,;Cioil E.tts._< jiui q)pJv iili a:t +`, � toj- :, i
_i�,�s1i4 all <�
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION Cl-,Acv (3Lk4+
Required. ./
MECHANICAL
Mechanical Contractor's Name: Business Name:
Address lG( /'� % �� /� City ,C z,.� Z.1. _ State
Contact Phone: ( ) 1 % %/ 1 3 Business Phone: (,/,e. .3 Z
Email
Fax Z- rs 7 ,s - - 6 Y ,
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) 6
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo )�� Dryer Vents C�
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
/ }c Decorative gas -fired appliance J
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets I �J
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Date
Range Hood Vents
Cook Stove Vents
Z Bath Fan Vents 1 J'
I The City of Rexburg's permit fee schedule is the same as required by the State of Idaho