HomeMy WebLinkAboutAPPLICATIONS - 06-00592 - Nelson Ricks Creamery - MechanicalDEC -01 -2006 FRI 03:32 PM FIRST CALL JEWEL FAX N0. 12085292793 P. 03
Sul. 12. cuu7 L;Llriw
CITY OF REXBURG F 0600592
13VILDING PERNET APPLICATION Please co, Nelson Ricks Creamery
19 E MAIN, REXBURG, ID. 83440 If the gaestio.
208 - 359 - 3020 X322 `� , Cnty Mechanical
PARCEL NZTMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCKS LOT#
(Addressing is based vn the information - must be w9yrate) , ,
PROPERTY ADDRESS:
CONTACT PHONE #
L - 'e ,LC,
PHONE #: Home ( } Work ( ) CCU( �'-� /� 0
OWNER MAILING ADDRESS: CITY:_ ,� STATE: ZIP:
EMAIL
FAX
Pte (If other than. owner)
(Applicant if otber then owtler, a statement authorizing applicant to act as agent for owner most accompt►ay this applicatwu.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP,
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR: Ah
MAILING ADDRE
CITY
PHONE: Home# Work# ell #_
EMAIL FAX
How many
are located on this property?.
Did you recently purchase this property? No Yes (If ycs give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
0,e., S,ittgle Family Residence, Multi Family, Apartments, remodel, Garage, Commercial, Addition, Etc.)
APPLICANT' SIGiNATURE, CERTIFICAnOAT ANZ AUTHORIZATION tinder p wry of *wy,1 hereby crifY that 1
Lave road thin applicadaa and slate that the infortootioa Darin is oottoct Md 1 swan that my ittformotian which re11yhac*4V be evon by mein hearings before rho
Planftg sod Zwina Commission or Slit City Coantril ,for the City of Rez" shall be nuWW and t nwt- I apse to c=PIY with aU City tegttlatiom and Stare laws
r ding 10 tbo subject manes of this applioetion and hereby auLhori2nd repreaeatMIM orate City to enter upoa Me above mandoacd property for hlspecdow ptupoees.
NOTE: The building official may ttvoite a acnoit on Mpmval issued under the provisions of the 2000 Intcmetiotwl CQ&- is etaea of nay false shat M=t or
ntmmFees mon of f=in the appticanon or on ft plans on which the paamit or approval was based. Permit void ifaaot Mud within 180 drys, Parrott void if wQ*
stops for 1 go days_
Siguat= ofOwnei /Applicant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
W.RN'ITiG — g[1ILAING P =MT!' Vogl' IM POST$A ON CONSTRUCTION 9n!v
Pfau im area twn- tKpn4ablo and an paid in lMtll at the UM of apptlasKua Deguning Jaunty 1.2W
City ot1 RetthwZ Aeeeptaoee of the plan rwivw fm dons of coustltaat a plan apprerral
EMAIL
STATE,,ZIP
CITY:
FAX
DEC -01 -2006 FRI 09;37 AM FIRST CALL JEWEL FAX N0. 12085292793 P. 03
may. 10. LVUO W 24AM � 0 No. 2140 P. 4
y
Beftae eomplete the entire Application! If the questi d oes not Apply in NA for li
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISTON
Regairedlll
MECHANICAL
Mechanical Contractor's Name; usiness Name. j 4�LL&r&LW,1,
Contact Ph ) r�( Business Phone, ( )
Email Fax
Mechanical Futimate S_ (Camm Farm,,► o rb )
F UURFS & APPLIANCES COUNT" (Singk Family Dwelling Only)
Fuma°e • Exhaust or Vent Ducts
Fumace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator system
Boiler
Pool Heater
Similar fixtarca or Appliances
Dryer Vents
RansG Hood vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts.
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) (M) Oil Coal Fireplace Electric
1Vlechnnical Sizing Calculations must be submitted with Plans & Application
Point of Delivery mush be shown on plans.
3igr►enu a of Lioeased Coimactor /Xj �'�` —
>:icaoae number p�
ay
The C!ry ofRexbwg's permJt fee schsdule is the same as rmutred by the State