HomeMy WebLinkAboutAPPLICATIONS - 07-00474 - 2272 Robison Dr - New SFR MechanicalC ° o f Rexbur / Madison Runty
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BUILDING PERMIT APPLICATION lest -se
19 E MAIN, REXBURG, ID. 83440 if the t it]
208- 359- 3020 X322
000474
2288 Robison Dr -Perez
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# _ LOT #
(Addressing is based on the information - must be accurate)
CONTACT PHONE # j_S_ -
PROPERTY ADDRESS:
PHONE #: Home (z t bZ Work
Cell
-49
OWNER MAILING ADDRESS: Ze CITY: 1�t STATE: ZIP:
EMAIL
FAX
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,
FAX
PHONE #: Home ( ) Work ( ) Cell (
CONTRACTOR:
MAILING ADDRESS:
CITY STAT
PHONE: Home #,Z - 7 y Work# Cell#
EMAIL
FAX
How many buildings are located on this property? 1
Did you recently purchase this prope No' Yes (If yes give owner's name)
Is this a lot split? (1� YES (Please brmg copy of new legal description of property)
PROPOSED USE: � i
(i.e., Single Family Residence,
Les &4 �
Remodel, Garage,
Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under penalty of peryury, 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 1180 days.
Signature of Owner /Applicant DATE
Do you prefer to be contacted by fax, email or hon ? Circle One
WARNING — BUILDING PE MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning Janum v 1. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval.
CITY:
EMAIL
N
le -A-se Co III plete tile, f 11fi e, if t j,4� t���:st �i�� vise Itt�r .x� t�i� fill iii NA for Boll t
tiplificable
NAME d g_ e-t'slZ --
PROPERTY ADDRESS ='` 6 od; r�, �� hermit#
SUBDIVISION u r? `i S c
Require ! rr
MECHANICAL
Mechanical Contractor's Name: Business Name:
Address `� a l ��1�� ��� t:✓ �S City ) cAk- State � Q. Zip
Contact Phone: Business Phone:��
Email �cl�� ���s�..�`�� �v= n �4ujzs -_Aj Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace —1— Exhaust or Vent Ducts
Furnace /Air Conditioner Combo i Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
j— Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Range Hood Vents
Cook Stove Vents
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.
4
i natun, vt' l,ie��,ns'. -A contractor License nUmber Date
i The City of Rexburg's permit fee schedule is the same as req uired by the State of Idaho