HomeMy WebLinkAboutAPPLICATION - 08-00174 - Merrill Construction - MechanicalCity of Rexburgl Madiso *ounty
BUILDING PERMIT APPLICATION' _i L �. f t� 0800 174
19 E MAIN, REXBURG, ID. 83440 _ ' `' `{, 1 '.7!;
208 - 359 -3020 X322 961 Russell Rd - Merrill Constr
PARCEL NUMBER: P C�-�� ) d, — ( We ...., Y .., ..... �..., �„� J
SUBDIVISION: UNIT# BLOCK # #_//_
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS:
PHONE #: Home (
ACTPHONE# /- 8� /- 73s-
Work ( ) Cell (
OWNER MAILING ADDRESS: TI 0, Garr ZfS CITY: Su tar STATE: ZIP: k3YY
EMAIL FAX
APPLICANT (If other than owner) r yl7em ` 77;rlr: ° Lon
(Applicant if other than owner, a statement authorizing applicdnt to act as agent fof owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 13 Z Z AA A � F CITY: So t r 6 4
STATE; rho ZIP &3YYY EMAIL FAX `/Z7G
PHONE #: Home ( ) &% - 1 Work ( ) &Z -WC Cell (
CONTRACTOR
MAILING ADDRESS:
PHONE: Home#
CITY
Work# Cell#,
EMAIL FAX
6
How many buildings are located on this property? -0-
Did you recently purchase this property? No es If yes give owner's name) Tosef 60d k
Is this a lot split NO YES (Please bring copy of new legal description of property)
PROPOSED USE: Si'n I le
(i.e., Single Family Residence, Multi Fdthily, Ap
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
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.
Signature of
DO you pr(
3S /-/
t' nnnnnn Ca
09" i i oer
DATE
o be conitgled by fax, entail or phone? Circle One
W ANMG — BUILDING PERMIT 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 he does not constitute plan approval.
2
� y: , �•� �. .. 1 tom:: t.. si (a .115 �!, �i! :S ,i,
NAME ?ose_ 60 Ole,
PROPERTY ADDRESS Slock, Permit#
SUBDIVISION 'j2lt,ers;c1e 4c res
MECHANICAL
Mechanical Contractor's Name: 0la -'r- �';��e Business Name: 34-6 Neo_A y
Address L SJ X/, 30001 City __pea j 6v _ State _Tc(aAo Zip S,3YYO
Contact Phone:
Email
Business Phone: ( ) 21,3 - 000(o
Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dweging Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo / Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
_ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) (FOil Coal Fireplace Electric
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
/ Alate
/ Range Hood Vents
Cook Stove Vents
Z Bath Fan Vents
i The City of Rexburg 's permit fee schedule is the same as required by the State of Idaho