HomeMy WebLinkAboutAPPLICATION - 07-00329 - 2778 Little Town Dr - New SFR MechanicalY
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BUILDING PERMIT APPLIC./ATION
19 E MAIN, REXBUIZG,, ID 8 3440
208-359-3020
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2 7 78 Little Town Dr-Porter
SUBDIVISION:
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PHONE#-.HonLe ( )_ �S�C'.-7/ y( Work
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OVV NER MAILING ADDRESS: CITYe
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"PH.CANT-. (If other than owner) ke-C :. / ..._.- ��' ,�'' . - ,
(Applicant if other than owner, a statement authormng applicant to act as agent for owner mai# accompany th
APPLICANT INFORMATION: ADDRESS � `� ,,�9�;J' _ t�_ CITY:
STATE
ZIP EMAIL
P1,10NE #-. Home(r_7 7
aWork )
it CONTRACTOR:
).3134,�7�� Cell
MAILING ADDRESS: 6G_S �- ��7'4 / CITY
i PHONE: Home#3 3 Work# cell# 31;3 - �
EMAIL �srL�s"F� FAX
how many buildings are located on this properly? 7X_t.-4a_ - -
Did you recently purchase this property? No YPS f Yes give ovmer9s name)
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s application.}
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STATk ZIP--
Is this a lot split�IVO _SES (Please bnng copy of �a�w legal description of property)
PROPOS2-a��'
., mgle Fami
ly Residence,L
fly, Apartments, R;
1, Garage, Commercial, Addition, Eta.)
11
APPLICANT'S SIGNATURE, CERTIFICATION'AND AUTHORIZATION: Under penalty of perjury,l hereby certify that
have mad this app] i cabon, and state that the infonnation herein is correct and I swear that an, y inform aon whi ch may he after be given by me in hearings before the
Planning and Zoning Commission or the City Council for the City of Rexburcr shall he truthful amd corrin. I agree to comply with all City rcguiaflons and State laws
relating the subject matter of this applicafion and hereby autborizedr r,. ti s of the City to enter upon the above-mcntioned propertyfor i oqion
NOTE: The building -offi cial rrzy v� v oke a art on approval issued wder the provisions of the 2000 Int,,; -m ationai Code in cases of any false statement or
misrepresentation of fact in the application on the p I ans on whi ch the pem it or approval was b ased. Perm it voi d If not swell with in 180 days. Perm it vo id i F work
stops dor I SQAYS.
SigK_ature
. r-)- o you r er J
pliant
'rte
DATE
5 be cont-icted by fay, ei aii or phone? CircleOne
W _ BU11MING PERAUT hMST BE POS
UMD ON CONSTRUCTION
Flan fee are non-refundable an are paid iim full at the time of appUcation beginning Januag 12 2005.
City of Rexburg'sAcceptance` the plan review fee does not consfituite plan approval.
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Mechanlocal Contractor" s TN"ame:
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Address qpr ,
Business Name -m-0
Contact PhoneM� �f /' , �' Business Phone�
Fax
Email
� a�iMiulfi Family Only)
Mechanical EstiMate $ (Cc
Fur�.ace/Air Cvnditianer obo
Heat Pump `�
Air Condgtivner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appl'
Incinerator System
Boiler
Pool Heater
A Ap-,oliances
i; e-�
S 1*1 -milar fixtures or
inclu,Fuel Gas Pipe Outlets d. i nig stWobed in or future outlet
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Inlet Pressure (Meter- SuppIY) PSI
lac Elect-fic
I Gas Oil Coal irep
Heat (Circle all. that aPP
40AF
State Zip
L,-3
Dryer Vents
Range Hood Vent, -q--4
Cook Stove Vents'
Bath Fan, Vents
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other sirnflar vents & ducts.
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Th.oe C ity- of R ex h urg " s p erm itf h e d1i lko- is the Sam 0S r
Date
w if by irea the State of Idaho
Madison County / City of Rexh-erg GIS
Page I Of 1
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DISCLAIMER.- This map is intended for display purposes only and is not intended for any legal representations.
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DISCLAIMER.- This map is intended for display purposes only and is not intended for any legal representations.
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