HomeMy WebLinkAboutAPPLICATION 1 - 0700136 - 1513 Red Cedar Rd - New SFR MechanicalCity of Rexburgl Madisow'ounty
1 - , ,
BUILDING PERMIT APPLICATION l - lecd,�t', 00136
19 E MAIN, REXBURG, ID. 83440 11 thki q.1 1513 Red Cedar Rd -Cnty Mech
•208- 359 -3020 X322
PARCEL NUMBER - c' ) \--) (� (�-� L'L' L ( W e will provlae uus ror you)
SUBDIVISION: 5C��� t � UNIT# BLOCK# LOT #_(_
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS: I I C� � E CA
PHONE #: Home (
OWNER MAILING ADDRESS:
EMAIL
STATE: ZIP:
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 (
Cell (
CITY:
FAX
CONTRACTOR
MAILING ADDRESS: tt *2 419 "Ie- CITY 0OXA444' STATE ZIP
PHONE: Home# Work# - ;91 - 2'3 Cell#
EMAIL FAX 3 ' r 2 Z ?
How many buildings are located on this property?
Did you recently purse this property? NV Yes,(9 yes give owner's name)
Is this a lot spliKNO/ YES (Please bring copy of new legal description of property)
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 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
stops for 180 days.
Signature of Owner /Applicant Arg
'I`�A 1 i U V Li: Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CON T r
Plan fees are non - refundable and are paid in full at the time of application � �3o 0]
City of Rexburg's Acceptance of the plan review fee does not constitute pl
Work (
1010
FAX
CITY OF REXBURG 1 2
Flv. It t- coll1j)I te, Olt- �'�1
NAME
• PROPERTY ADDRESS
SUBDIVISION
Permit#
equir c . 1 MECHANICAL
Mechanical Contractor's Name: usin Nam
Address City State_
Contact Phone: (
Email
Zip
Business Phone: ( )
Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES 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
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
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.
`'�lu?3'iHltil' "J �� �.iv'ti;i1 't� C'x>39I "fh:[UI' L1C2115L Illlll717�1'
Date
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
I The City of Rexburg 's permit fee schedule is the sa as required by the State of Idaho