HomeMy WebLinkAboutAPPLICATIONS - 06-00601 - 221 S 1st E - Mechanical6-1 OF REXB URG PERMIT #
BUILDING PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the qua 0600601
208- 359 -3020 X322
PARCEL NUMBER: '
�� ( 221 S 1st E- Mechanical
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
.... I
CONTACT PHONE #
PROPERTY ADDRESS: ZZ-1 S 1 54- F. ?e-s �LA g S 44
PHONE #: Home (, �5(oT Z� Work ( ) Cell P8) 5 Z,7 5
OWNER MAILING ADDRESS: Cckmamel.e CITY: uw STATE O3A40
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
STATE; ZIP
PHONE #: Home ( ) Work ( )
CONTRACTOR
EMAIL
%4 %A
CITY:
FAX
Cell ( )_
NQ
MAILING ADDRESS: O• - 7 r CITY
PHONE: Home# Work# ' S 5L - 1 }I I I Cell #_
EMAIL
FAX ZS6- GjOSS
STATE ZIP 9344 D
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, Multi Family, Apartments, 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 corre.g. 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 Owner /Applicant DATE
Do 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 January 1. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
"Building Permit Fees are due at time of application" "Building Permits are void if you check does not clear"
-4-
applicable
011: If the question does not a
NAME Prz; ce _�)c_, e k p o w V
PROPERTY ADDRESS Z.21 .5 1s4 E x
SUBDIVISION
Permit#
NA for non
Required!!! MECHANICAL
Mechanical Contractor's Name: UXA \ i'a Business Name:
Address 1 ?.0 , �oX �7 City' e State Zi
p _jq3A4L D
Contact Phone: ( ) Business Phone: (fig) 356 - 4 ► ► I
Email Fax
Mechanical Estimate $ 1 (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
_ Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Dryer Vents
Range 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) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licens d Contractor License number
The City o f Rexburg s permit fee schedule is the same as
jQ 7 � 2�
Date
by the State o Idaho