HomeMy WebLinkAboutAPPLICATION - 06-00617 - 2306 E 1000 N - New SFR MechanicalCITY OF REXB UR G
BL'ILDIIv'G PERMIT APPLICATION
19 E MAFN,, FEXBURG, ID. 83440
208-'359-3020 X322
Please,
If the que,
PARCEL NUMBER:
PERMIT
06 (j(")6 17
()6 F 1U00 N-Cntv Mech
SUBDIVISION: UNIT# BLOCK4
(Addressing is based an the information - must be accurate}
OWivER NAME -2 � o kev�&VL-
PROPERTY ADDRESS: ZSC(o
PHONE#: Home ( )
t
OWNER MAILNG ADDRESS: "
Work
V1__ CONTACT PHONE 9
LMAIL FAX
LOT#
CITY: SOVL, STATETIF
Jb ZIP:030Q
APPL I CANT (If other than flwwn..er)
(Applicant if other than owner, a statement authorizing applicant to act as went for owner must accompany this application.)
APPLICANTINFORMATION: ADDRESS
STATE;
PHONE#-. Home
CONTRACTOR:
MAILING ADDRESS
CITY:
ZIP EMAIL FAX
Work ( ) Cell
v�F,
3,
CITY
PHONE: Home# Workl cell#
EMAIL
FAX *: �S 6 - !��O S'S.;o
How many buildings are located an this property
STATE Z',� ZIP
L)Ya you recently purchase this property? No 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:
(i.e., Single Family Residence, Multi Farni'ly, Apartinents., Remodel, Garage, Commercial,, Addition, Etc.)
APPLICANT" S S1GNA'1'URE,, CERTIFICATION AND AUTHORIZATION: Under penalty
that 1 have read. thi.s 1 *) a�ti �n and state that the nform ti �n herein correct ani I we r that ars information ation � hi h rn � hereafter given b m
in hearings before the Planning and Zoning � �i i r� � the City Council for the City Rexburg shall he truthful and correct. I are to comply
with all City. regulations and ate laws r0ating to the subject matter of this applicati rx and hereby uthri ed representatives of the City io inter
upon the above -intentioned property for i'nspecti.ons purposes. T The building off i 'iX may revoke a perift on approval
provisions f the 2000 Int:emati n l Code in casesany false statement or misrepresentation f fact iri the lie tin F n the l n ivhi �.
�� � �. the
permit or approval was based. Penult void if tint started Within 180 days. Permit void if work stopsfor 180 def .
L-)181,aLuiveDATE
refer contacted fay
' I r hone) Uncle One
WARNING — tNG PERMIT MUST BE POSTEDCONSTRUCTION SITEI
Plan fees are non-refundable n are paid in full at the timeof application beginning January 1., 2005.
City of Rexburg's Acceptance of the pian review fee does not constitute plan approval
wilding Permit Fees are due t time ofapplication" � � u i
"Building ng Permiks are void if you check dyes not clear"
0
0
Please complete the entire Application! if the question does not apply rill iii N:1 for uon
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Required!! �is
"I� V;,\40 vk
Mechanical Contractor's Name,:
Addre
i
1
101
�,XROV, rad
MECHANICAL
Fe \X. -40 t I e �
Contact Phone : (236 )
Pennitff
Business Name: �� t
City �' �..� -`' � State..�,.�'%41E)zip
Business Phone: ( ) -S -- 14- j J'
Email Fax
Mechanical Estimate $ (CommerciaVMulfi Family Only)
FIXTURES & APPLLINCES COUNT (Single Family Dwelling, Only)
Furnace Exhaust or Vent Ducts
I Fumace/Air Conditioner Pomba
Head Pump
Air Conditioner
Evai)Gooier
Unit Heater
Space Healer
Decorative gas-fired apphance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
� Dryer Vents
Range Hood Vents
Cook Stove Vents
� Bath Fan Vents
'7 Fuel Gas Pipe cutlets including subbed in or future owlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply). Oil Coal Fireplace, Electric
other similar vents & ducts;
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown an Plans.
Signature of LlcensAd Contractor
License t7Litllber
The City of Rexburg's permit_ fee sehedulc� is the same as required bv the State of Idaho