HomeMy WebLinkAboutAPPLICATION - 08-00516 - 4292 S 1000 E - Webster1311 1 Vl' n i i� V�
BUILDING PERMIT ICATION Pleas ' 005 16
208 3 s "�o2 0 z G' S3440 rfi t; q 4292 S 1000 E- Webster
PARCEL NU UR: ' ((i �
SUBDIVISION: UNIT# BLOCK# LOTW
(Addressing is based on the ioformatiom . )must be wourata)
D R; 1 CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home ( ) Work ( ) deli
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
�WANT (If other than
(Applicant iifother than otter, a statement authorizing applleant to act as agent for owner must accompany this
APPLICANT INFORMATION: ADDRESS I /2, �9�d CITY; s
S TATE; ZIP EMAIL FAX `7f
PHONE 0: Home
Work ( ' ) 7 v Cell ( )
CONTMCT0R
MAILING ADDRESS:
CITY 0 5 STATE_,LZIP
PHONE Home# Work# , Ca11#
EMAIL FAX te 9 W.2 72= -
Row many buildings are located on this properly?
Did you recently purchase -this property? No Yes (If yes give owner's name)
Is this a lot split? NO 'YES (Please bring copy ofnew legal description ofproperty)
PROPOSED USE:
0.e., Slrgje Family Residence, Muld Pamlly, Aperhnents, R=odal, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTITICAUONANDAUTHORIZATIbN: Under Penalty afperjury,I hereby certifythetI
have lead thin application and state that the infonnsdon hctcin is co rca and f swrar Ilmt any iufotmoti on which may hcros rr bd ; van by free in hearings hefbre the
Planning eQd Zoaing 0 0ww elon ortho Clty Cotmoil *r tho City ofplacburg shall ba tnrtUll and cornett. 1 agm to comply with all City regulations and State laws
rclating a the bvtjeet mattx of this application aqd hereby authorized repnsmta lim of the City to aatw upon the above- mcpdoaed Propm for inapwdow Dwpoees.
NOTE: Tho bulldingeficiaJ may rcvuke a permit oq approval issued under the ptovisiom ofthe2000 Intemadonal Cade in com ofafly f%Jsa ztataumt or-
minepresaatatioaoffsaintheappilmminoronthapimsonwhJohthepataltorapprowlwasbastd, PermitvoJdicfw(3% adwithin180days. Permit v oidifwork
stops for ISO days. r
Signature cfOwzm/_A t DATE
Do you prcfer to be contacted by fax, email or phone? Clrcle One
wA Mr, BUILDING PERMIT MUST IM POSTED ON CONSTRUCTION M31
Plan few are non - refundable and are Dold la fad at the fling of appticatlon begtaning At94rp 1 2041
City ofReshnrg's Acceptaaea of the plan reviorw fie don not conatrtata pNa approval
vV• IJ• &V V. L•LL
Please complete entire Application! it the y
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
not apply 1111 In NA for non
Permit#
Requiredlll MECHANICAL
Mechanical Contractor's Name; T j usiwess Name; /�Lyr��
Address City State Zip
Contact Phone; S2 �;Z - 7 7 7 7 Business Phone: ( )
Email Fax T -C —a
Meebanieal Estimate S (Commercial/Mult3 Family Only)
FIXTURES & APPLIANCES COUNT
(Single Family Dwa ing Only)
,4, Furnace
Exhaust or Vent Ducts
Furnacc/Air Conditioner Combo
Dryer Vents
Heat Pump
Rfuige Hood Vents
Air Conditioner
Cooly Stove Vents
Evaporative Cooler
Bath Fan Vents
Unit Heater
other similar vents & ducts: "
Space Heater
Decorative gas-fired appliance
Incinerator System
b Boiler
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PST
Heat (Circle all that apply) Gas Oil Coal Fircplace(Llecgid
Mechanical Sizing Calculations must he submitted with Plans & Application
Point of Delivery must be shown on plans.
-�. - Z ZZ
Signantre ofLlec+nsed Contractor/ License number
Required!
The City of
schodule is the same a4
11;2 3
Date
the State gf1daho
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