HomeMy WebLinkAboutAPPLICATIONS - 07-0278 - 5180 S 2000 N - New SFR MechanicalJun 20 07 11:32a
Ma r. 4. 2005 2:47FV •
CrY OF REXB URc
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440 Please 4
208 -359 3020 X326 If the questi
PARCEL NUMBER: L,2N4� c c U 1") V
SUBDIVISION:
lo. 0495 F. 2
nCTl :fTT 1!
0700278
p.2
5180 E 2000 N- Pocock
UNIT# BLOCKm LOTS
OWNER: l(I n J 00 1 j +ezn �(� CCU -k— CONTACT PHONE
PROPERTY ADDRESS: 1 5 1 ? 0 E• 2.W N
PHONE #: Home ( ) Work (
OWNER MAILING ADDRESS:
Cell (
V3q4-?
CITY: STATE. ZIP:
APPLICANT (If other than owner) L,t',nan kt y
(If applicant if other than owner, a staternent suthorizine applicant to act as aecnt for owner must accompany this application.)
MAILING ADDRESS OF APPLICANT
ibc[ 'W , l O+ h isi; CITY: STATE; 1 GII ZIP
PHONE #: Home g4) 5Z - 4 - 3 ' 1 Work ( ) Cell ( )
CONTRACTOR: 00 Z & PHONE: Home Work.4 Cell
MAILING ADDRESS: 4cl 1,t? - � t CITY 161c ( 44 STATE - ZIP 3{C`
How many houses 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 YY
(i.e., Single Family Residenc., Multi Family,
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHO.RI.ZATION: 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 1 .000 International Code in cases of any false
statement or misrepresentation of fact in the application or on plans on which the permit or approval was based. Permit void if not
started within 130 days. ?=it void if work stops for 180 days.
Signature of Owner /Applicant
?SqUZ
�d / Q 0 /
DATE
WARNING — BUII.DINIG PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are aon refundable and are paid in full at the time of application beginning January 1. 2001.
C4 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"
Jun 20 07 11:32a
Feb. 8. 2006 1:58PM •
• No. 1624 P. 5
Please complete the entire Appl icat ion ! It the question does not apply fill in NA for non
applicable
NAME (6'IA , 4 CC )i I (Ln cLL
PROPERTY ADDRESS 5 ZO C ?D lr) o = c �C' Permi R
SUBDIVISION
p.3
Required!
Mechanical Contractor's Name: Q nan i r7 c. Business Name:
Address 1 4 Zti w 1 - t City a nl cjn o 1-c.j State T1 Zip L3`40,1
Contact Phone: (,) �jc Z 12 Business Phone: ( )
Email Fax es` �L``I - 21 C5
Mechanical Estimate S (Commercial/Multi. Family Onb)
FEL7URE,S' A APPLIANCES COU1VT (Single Fancily .Dwelling Orly)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
•�- Heat Pxnp
Air Conditioner
Evaporative Cooler
Unit Heater
I - Space Heatez
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
J Layer Vents
Range Hood Vents
Cook Stove Vents
_ c 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.
signatwe o Licensed Contractor
The City of Rexburg 's
AVL C . i ��'
License number
schedule is the same as
Date
the State oflda