HomeMy WebLinkAboutAPPLICATION - 07-00453 - 3928 Orrin Ln - New SFR Mechanicall
o Rexbun / Madisonoun
City .f g ty
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X322
•
0700453
3928 Orrin Ln- Chapple
PARCEL NUMB" ( 'we waai FA V v tuc. uuJ — , - -,
SUBDIVISION: 2, f Q UNIT# BLOCK# / LOT#
(Addressing is based on the information - must be accurate)
CONTACT PHONE # SCS7 -- G yo — od
PROPERTY ADDRESS: 3q%:':9 orf ofin ZA �?
PHONE #: Home ( ) 35 'AM Work (10 69'0 - CJc-a5"3 Cell ( ) .S4-
OWNER MAILING ADDRESS: 73-1 S y U CITY: PQ STATE: I)ZIP: FYOVO
EMAIL FAX VO' 1 °
APPLICANT (If other than owner) /~I E-
(Applicant if other than owner, a statement authorize ica#to act as agent for owner must accompany this application.),
APPLICANT INFORMATION: ADDRESS /P9 SR49 k `1 Lr CITY: Al I &r
STATE; 17,,' ZIP MAIL FAX
PHONE #: Home ( ) Work ( ) Cell( ) 517 - ? 5 91
CONTRACTOR 7k Cu tie sz: �
MAILING ADDRESS: AQ / CITY ' �i, STATE I D ZIP y�Ib
PHONE: Home# _ Work# Cell# 3/7-24'81
EMAIL FAX �W— /S 0
How many buildings are locat-,(1 an this property? _L__
yes give owner's nante)__
Did you recently purchase this property? N
Is this a lot split ?� YES (Please bring copy of new legal description of property)
PROPOSED USE: _ S i
(i.e., Single Family Residence,
4 ;_6
9
ulti 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 r permit on approval issued under the provisions of the 2000 International Code in cases of any false statement or
misrepresentation of fact in on or on the I which the permit or approval was based. Permit void if not started within 180 days. Permit void if work
stops for 1 g0 days. -
Signature of Owner /Applicant = "*AT)r
I)o you prefer to be contacted by fax, email o phone? Ircle One
WARNING — BUILDING PE ST IIE 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.
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NAME
PROPERTY ADDRESS Permit#
SUBDIVISION SAS I C_A'ro_.k
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R qu i..pe 1
MECHANICAL
Mechanical Contractor's Name: scl itt" Business Name: C)
Address Sk h G-` 0- City " State LD Zip �'Ho
Contact Phone: ( ) 43So —S ys' Business Phone: ( ) S4
Email Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FEgVRES & APPLIANCES COUNT (Single Famil Dwelli Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
0_ Unit Heater
Space Heater
/ Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
/ Dryer Vents
Range Hood Vents
a Cook Stove Vents
* 2 Bath Fan Vents
other similar vents & ducts:
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
_t 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.
#go - # 0 ;
�i}� da4.Ttt3]' -J l� 1Cr9t�'r� lrDilt.it)1" Ll +.('�h° 11LS.i]3G�1" Date
6 The City of Rexburg s permit fee schedule is the same as required by the State of Idaho