HomeMy WebLinkAboutAPPLICATION - 07-00459 - 2757 Diamond H Ln - New SFR Mechanical•City of Rexburgl Madiso>ounty
BUILDING PERMIT APPLICATION :: ,1,
000459
19 E MAIN, REXBURG, ID. 83440 = 2757 Diamond H Ln- Walker
208- 359 -3020 X322
PARCEL NUMBER: We will provide this for y ou) LOT#
SUBDIVISION: UNIT# BLOC K #
(Addressing is based on the information - must be accurate)
OWNER: pp�
PROPERTY ADDRESS: nC 9
PHONE #: Home ( ) Work ( )
OWNER MAILING ADDRESS:
EMAIL FAX
'ACT PHONE #
Cell (
CITY:
STATE: ZIP:
APPLICANT (If other than owner)
(Applicant if other than owner, a statement
to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRES �A � YG , C ITY:
STATE; _ ZIP EMAI & FAX
PHONE #: Horne (?e6 - a 30 z Work ( )_ c— ,c�ru� Cell ( )
CONTRACTOR
MAILING ADDRESS:
PHONE: Home#
CITY
Cell#
STATE ZIP
EMAIL FAX
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 peiJury, I hereby certify that 1
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 issued under the provisions of the 2000 International Code in cases of any false statement or
misrepresentation of fact in the application or o e plan s o permit or approval was based. Permit void if not started within 180 days. Permit void if work
stops for 180
q e n wrier /Annlicant DATE V
Do you prefer to be contacted by fax, efliail or phone? Circle One
WARNING — BUIIAING 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.
Work#
E
..A 3
NAME Gil S�ZE Con ",,4 . LL.(I-
PROPERTY ADDRESS cmb- 14 Ale-, 11' J Permit# J44 _p 1-
0
SUBDIVISION SA C f p J
Requi e 1 MECHANICAL
Mechanical Contractor's Name: At�n ��^/ Business Name: j� ,�( 4� � _e
Address 1 A V- 0 6e r br Ne_ City pA-� State Zip ks�
Contact Phone: (xb) "409 Business Phone: (, - 1-0 1 ) - Z
Email 0 2F q gej4-� & ygo-&, Fax AU&
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT
/ Furnace
01 A Fumace/Air Conditioner Combo
Nr A Heat Pump
Air Conditioner
t4ll� Evaporative Cooler
N� Unit Heater
–
&JA — Space Heater
Decorative gas -fired appliance
K JA Incinerator System
Boiler
tj J j + Pool Heater
(Single Family Dwelling Only)
Exhaust or Vent Ducts
Dryer Vents
/ Range Hood Vents
rJ)A ± Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
1 A Similar fixtures or Appliances
15 Fuel Gas Pipe Outlets including stubbed in or future outlets
O - ig Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) (E) Oil Coal Fireplac Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
I The City of Rexburg 's permit fee schedule is the same as required by the State of Idaho
C /// 3 0
I bate
I The City of Rexburg 's permit fee schedule is the same as required by the State of Idaho