HomeMy WebLinkAboutAPPLICATIONS - 08-00444 - 1112 Desert Rock - Mechanicals
City of Rexburgl Madison County
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X322
•
08 00444
1112 Desert Rock- Beattie
PARCEL NUMBER: ,QP 00 5T/f Oa ao a 10 A (W,
SUBDIVISION 4esert Rock. UNIT#
(Addressing is based on the information - must be accurate)
BLOCK# LOT# 7
OWNER: 1.31owk 1_ CONTACT PHONE # 7d5 -oSYG
PROPERTY ADDRESS: ///- S . Df5 ere 90 r-k i)r
PHONE #: Home (Zcg) 356 o9 -1L W
6L6 -f y 'ly
k3 'lc)
Cell (zo) 705
OWNER MAILING ADDRESS: &a»Le r s pn o& CITY: 9,ft� t±n STATE: T-6 ZIP:
EMAIL Gdbahiid yaltca. &rw� FAX ti/A-- 1 /-000 w, / / /a,$.
APPLICANT (If other than owner) N .9
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) -- Cell( )
CONTRACTOR
MAILING ADDRESS:
PHONE: Home#
EMAIL
CITY STATE ZIP,
Work# Cell#
Imo:"
How many buildings are located on this property? (a) how a- 5keA
Did you recently purchase this property? (fo Yes (If yes give ow name)
Is this a lot split? �� YES (Please bring copy of new legal description of property)
PROPOSED USE: X doh - i'o
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial,
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 Intenuuional 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 I S days.
S ature of Owner /Applicant DATE
Yam you prefer to be contacted by fax, email or ion ? Circle One
WARNING — BUILDING PE ST 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
NAME
PROPERTY ADDRESS ///, • a°se+ - ✓Lr-� b
SUBDIVISION &k-
0
I _t31 (1 :sfji)t1 Ju J -1 o'. wid'i (111 ill 1`, 7u >l1
y000 w• MW ,
iiid S
Permit#
a
MECHANICAL
Mechanical Contractor's Name: X Business Name:
Address
Contact Phone: (
Email
Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
_ Furnaces 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
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 it Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
l> Date
ir-
City State Zip
Business Phone: ( )
9 The City of Rexburg's permit fee schedule is the same as required by the State of Idaho