HomeMy WebLinkAboutAPPLICATION - 07-00546 - 1303 Red Cedar Rd - New SFR Mechanical• City of Rexburgl Madison -T unty !
BUILDING PERMIT APPLICATION 1 0 7 0 054 6
19 E MAIN, REXBURG, ID. 83440 -`� y f LIU 1303 Red CCdc`11 Rd- Moseley
208- 359 -3020 X322
PARCEL NUMBER:_ �� dtil O ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK #
(Addressing is based on th Information - must be accurate)
CONTACT PHONE #
OWNER: /,I l!l `Z
PROPERTY ADDRESS -.�� 93q-Yo
PHONE #: Home (y_ P Work Cell 1 4 9 2(m
OWNER MAILING ADDRESS: //-ly� 4� CITY: STATE ZIP: 3L /y �
EMAIL FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent or owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS /G/�/kl !/(j ,62f CITY:
STATE; LD ZIP EMAIL - FAX
PHONE #: Horne ( ) ?Stp S�19� Work ( } ?9 /a -Syg7 Cell(
CONTRACTOR
MAILING ADDRESS: � �/ -/000 1/t/ CITY S
� TAT ZIP �
PHONE: Home# 350 - 5`Y , 7q Work# 39 Cell# 3g 0 - Sys?
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property? No (1 1f yes give owner's name,
Is this a lot split NO YES (Please bring copy of new legal descriptiR
PROPOSED USE: f;;Vn lC "
(i.e., Single Family Residence, Multi Family, Apartmen s, Remodel, Gars , CommerciRl 4f0itioN
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZAT ON Under f -eerti that I
have read this application and state that the information herein is correct and I swear that any information whi m { �v fo the
Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and cmtt I e � 9 all laws
relating to the subject matter of this application and hereby authorized representatives of the City to enter upon property for inspections purposes.
NOTE: The building official may revoke a permit on approval issued under the provisions of the 2000 Intemational 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. _ A
Signature of Owner /Applicant DATE
Do you prefer to be contacted by fax, email 4r phoney Circle One
WARNING — BUMDING 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.
2
_..1'. ='i >' g_��'�,�:.ii.� � _f?.� 1� 3s':�itil;t3 t�; 1� .,. it:'- _ • �`
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Require
MECHANICAL
Mechanical Contractor's Name: T)AV 1 G' �') LAM Business Name: J AAAC I V (-
Address S le L j (O N City C = F - )tf)M State - ZD Zip � 9 � S
Contact Phone: Ll &P 1 Business Phone: PC
Email
Fax 021q — "7 2-Z
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
'I Furnace t Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
I— Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
�j 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.
I I(o�1 10-k-0 - )
rs,I Date
1 The City of Rexburg 's permit fee schedule is the same as required by the State of Idaho