HomeMy WebLinkAboutAPPLICATIONS - 08-00011 -1132 Crescent Dr - MechanicalCity of Rexburg/ Madison0ounty p�R"''TT Adk'�7'1 1 `O
BUILDING PERMIT APPLICATION 0
19 E MAIN, REXBURG, ID. 83440 t �'��,
208 -359 -3020 X322 1132 Crescent Dr -North
PARCEL NUMBER � (Wt
SUBDIVISION: It a.V UNIZ.. ----_- F -- -
(Addressing is based on the information -must be accurate) ' 13 Z D�(
OWNER wi S CONTACT PHONE # _g y
PROPERTY ADDRESS:
PHONE #: Home ? t qS Work ( ) Cell � �03 `fit �
er: ,1 STATE: ZIP: ?3Y D
OWNER MAILING ADDRESS: S S. �{f"( V eS f CITY: d _�
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 EMAIL_
PHONE #: Home ( ) Work ( )
CITY:
vi
Cell ( )
CONTRACTOR w k, I la1 r c. yod 6f ? rae C— a-'
MAILING ADDRESS: 3 � 3 f- q f" /U• * ( U CITY . rb STATE TV ZIP 8 3Yc��
PHONE: Home# Work# 3S� S uer/. Cell# SZ c( - 3 o /
EMAIL FAX 35� SS
How many buildings are located on this property?
Did you recently purchase this property? No (9(If yes give owner's name)
Is this a lot split` YES (Please bring copy of new legal description of property)
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 revoke a permit on approval issued under the provisions of the 2000 International Code in cases of any false statement or
misrearesentatiprO fact in the applicgidn or on the plans on which the permit or approval was based. Permit void if not started within ISO days. Permit void if work
stops for "S.
s. �' .��
3 /���
Si re of Owner /Applicant DATE
you prefer to be contacted by fax, email or qjof 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 fee does not constitute plan approval.
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$ ;_+' : N)k a !3..,
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NAME
PROPERTY ADDRESS /13 Z_ Permit# /6
SUBDIVISION 5C/
R equired! !! MECHANICAL
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Mechanical Contractor's Name: L Business Name: / Q,"
Address City St 4 - �c State zip 0
Contact Phone: ( ) 3 �� Business Phone:
Email
Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT
Furnace
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
(Single Family Dwell' Only)
Exhaust or Vent Ducts
Dryer Vents
i Range Hood Vents
Cook Stove Vents
_ Bath Fan Vents
other similar vents & ducts:
I -� 5
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) G Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
of Delivery must be shown on plans.
1 /;/0 ff
Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho