HomeMy WebLinkAboutAPPLICATION - 06-00484 - 4781 N 495 W - New SFR MechanicalCity of Rexburg/ Madisa �ounty
BUILDING PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If -the car
208-359-3020 X322
PARCEL NUMBER: PDL �LYZ. (�� � L C).,J
SUBDIVISION: U
(Addressing is based on the information - must be accurate)
t�
0TPNE:
A.
PERMIT #
ohman
4781 N 4Q-.-lr5 �B,
PHONE#: Home (yZy)� �{'? — .��(� Work Celi (fob) -7 i
O"ER MAILING ADDRESS: / i�2 z� s.�,z� �:cITY: dei l et/ ue, STATEN±.A ZIP: I Fl00g
EMIL FAXa
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APPLICAAIT: (If other than owner}
(Applicantiff other than owner, a statement authorizing appli
APPLICANT INFORMATION: ADDRESS
ZIP 63 y o �
PH0NE_'#:'Home �$) AqZ—� �bk Work ¢� ) AIA Cell &jx)
cant to apt as agent ror owner mast accompany this application,)
CITYd-
'FAX(9,08
04
4
r.
r
PHONE: Homeg 54 7---b 96 5 Work# cell# 7UEf—�BZZ.
EXIAlLabi;��C 3�ue-Cu,lc.� FALX
How many buildings are located on this property? 0
Did you recently purchase this property?Yes (If yes give owner's name]
Is this a lot split? NO .. YES(Please bring copy of new legal description of property)
PROPOSED USE: � s.:Lot x�- es &elf\
(i.e., Single Family Residency, Mufti* Family, Aparftants, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S S CERTIFICATION AND AUTHORIZATION: Under penalty
have read this application and sWe that the information herein is correct and I swear that any information which may hereafter be givenme in hearings before the
l ni g and Zoning Commission or the City Council for the City of Rexburgshall be truthful and correct I are to comply with ail City regulations and State laws
relating to the sub j ec t matter o this i application i cation and hereby t representatives t to enter uabove-mentioned property for inspections purposes.
TE: The building official may revoke a permit on approval issued under the provisions of the 2000 Intemational Code cases of any false statement or
misreprescntation of fact in. the application or on the plans on which the permit or approval was based. Permit void if not stied within ]80 -days, Permit void i work
sops for 180 days.
signawre or Owner/Applicant DATE
Ido you pro -for to be contacted by Tex, email or, ho Circle OmWARNING-- BUILDING PERMIT MUST BE POSTED QUI CONSTRUCTION SATE'
Ptan fees ars nen-refundable and are paid in full at the time of application beginning January 1, 2005.
City ofRcxcburg's Acceptance of the plan review fee does not constitute plan approval.
0)
NA for non
-d, ()e!4,jjtjt ,japply irt.rl& question
i'lease complete the ents., Aj)PI"Caft0no If
3'3��1C `li)�U
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required
Mechanical Contract
Address � � �
<
or s Name: lLa.yn
av
Contact Phone: 019C)
All
..bM— city.
I Exhaust or Vent
Fh1.qine..q.v. Rhone: ti_�
6-wl, 2 j
(Comm.e* I/Multi Family 'Only)
Mechanical Estimate $ rcia
Furnace
��Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
___�_�w_� Boiler
Pool Heater
Similar fixtures
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath. Fan. Vents
`> Fuel Gas Pipe Outlets including stubbed in or fuhue outlets
�� Inlet Pressure (Meter Supply) PSI
Heat (Circle all that app1y)C:!j6"a 01'1 Coal Fireplace Electric
P,P�f,,.,W,.,ME&&APPLL4-NCES'C.OUNT (Single Family Dwell�ng Only)
Ducts
other similar vents
&ducts:
or Appliances
Mechankal S
0
izing Calculations must be submitted with Plans Application
Point of Delivery must be shown on plans.
IF
signatlix
Required!
P.
Licr,-n-ise nUMbel-
ti
31 o.-toviN
The City ofRexburg's permitfee schedule is the same as required by the State ofIdaho
Business Name: