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Home My WebLink AboutAPPLICATIONS - 07-00396 - 1767 W 4300 S - New SFR Mechanical, o y 'of Rexburg/ Madison Munty PERMIT # BUILDING PERMIT APPLICATION' r. 19 E MAIN, REXBURG, ID. 83440 `' f [A 07 003 96 208- 359 -3020 X322 PARCEL NUMBER: %C 1767 W 4300 S- BUZZeII SUBDIVISION: (Addressing is based on the information - must be accurate) fit 11 w,o,�. vJ V ,2`le \l CONTACT PHONE # PROPERTY ADDRESS: - PHONE #: Home Work( ) - Cell( ) OWNER MAILING ADDRESS: (b,10 - Fool 94 ,,M_% ; ITY: t 004, STATEN ZIP: P34q 3 EMAIL APPLICANT (If other than owner) 'S i f n ht 2 k i ►n t 1 c 1 I (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS I C' < � ��„�1 CITY: FX 6Af' STATE; ZIP EMAIL FAX PHONE #: Home ( ) AorC_ Work (acA) 361 &W Cell CONTRACTOR MAILING ADDRESS: PHONE: Home# FAX CITY Work# EMAIL FAX AUG 21 2007 How many buildings are located on this property? ! Did you you recently purchase this property? No Yes If yes give owner's nam C� Is this a lot split? N�OYES (Please bring copy of new legal description of property) PROPOSED USE: (i.e., Single Family Rest ence, 0 G Family, Apartments, Reinodel, 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. �_� ?,,�, & g / 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 Januarp 1. 2005. City of Rexburg's Acceptance of the plan review fee does not constitute plan approval. Cell# 2 ;i2 ,.. '.' +i;lii ;i i13 tY Pr ;i. ?,.sl NAME PROPERTY ADDRESS Permit# SUBDIVISION e ! MECHANICAL Mechanical Contractor's Name: Business Name: Address City State Zip 4, Contact Phone: ( ) Business Phone: ( ) Email Fax Mechanical Estimate S (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) I 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: 3 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. Range Hood Vents Cook Stove Vents Bath Fan Vents Date The City of Rexburg's permit fee schedule is the sam as required by the State of Idaho 3 ty of Rexburg/ Madisopounty PERMIT # -j:) BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 'I I I j E. al - "'osiVill d ov 110 i I I p!) 1 fill 14I _tN ck fo r Tion -a I A) I 208-359-3020 X322 PARCEL NUMBER: We will provide this for you) - S SUBDIVISION: C? kc� Q_ _ -* _�,.�UNIT`k_BLOCK# LOT# (Addressing is based on the information - must be accurate) OWNER: CONTACT PHONE PROPERTY ADDRESS: PHONE #: Home (20)_62S�`1 Work Cell OWNER MAILING ADDRESS: [LAH _ — STATEN ZIP`:_P EMAIL FAX (If other than owner) i t Dht rt L31MCIC I I (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS 16'4 -5 1&1 E CITY: Ae 030✓ STATE; 10 ZIP fW40 EMAIL 64fw6l 12E-Aw:3 . c, FAX PHONE #: Home Aofc_ Work (Acj) 361- ?CW— Cell (01 - 723V 3k V102 CONTRACTOR: MAILING ADDRESS: PHONE: Home# EMAIL CITY Work# FAX How many buildings are located on this property? Did you recently purchase this property? No Yes f 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 Re Family, Apartments, Relnodel, 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 coned 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 die provisions of the 2000 International Code in cam 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 with-in 180 days. Permit void if work stops for 180 days. 11_� g I J � - 1 2 - �D Signature of Owner/Applicant U 17 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 he does not constitute plan approval. —V%eA I -e V %,,, A -, � �'A c_- , c— Q__ Cell# STATE ZIP 2 flle - jl�p _. -p lk fi ff the glzeY boll fl.4 l 3 tNIZ fo r 11ola �. gg33 ' NAME PROPERTY ADDRESS Permit# SUBDIVISION = MECHANICAL Mechanical Contractor's Name: ' �'�'� Y -)Q ( - Business Name: Address City State Zip Contact Phone: ( ) Business Phone:( ) Email Fax Mechanical Estimate S (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) I Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Dryer Vents Heat Pump Range Hood Vents Air Conditioner Cook Stove Vents Evaporative Cooler Bath Fan Vents Unit Heater other similar vents & ducts: Space Heater Decorative gas -fired appliance Incinerator System Boiler Pool Heater Similar fixtures or Appliances 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. License number Date aF_ir�#? The City of Rexburg's permit fee schedule is the s ame as required by the State of Idaho 3