HomeMy WebLinkAboutAPPLICATION - 06-00010 - 3784 W 2000 S - New SFR Mechanicalpan, 3. ~f106 12,12Ph~
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B~~LDING PERMIT APPLICATION Please c
'" '~ 19 E MAIN, REXBURG, ID. 83440 If the quasi
20$-359-3020 X322
PARCEL NUMBER; ~1 C~ ~u ~~~~j~ ~ ( W
PERMIT #
SUBDIVISION: UNIT# BLOCK# LOT#
{Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS:
OOc~
PHONE #: Home ( ) ~..2 ~3 ~~ ~ Work ( ) ~Sr~ ~7 3L~ Cell ~ ) ,~
OWNER MAILING ADDRESS:,,~~ tJ~ ~ .~~t ,CITY: ~ TATE,~ZIF:r~~S~J
EMAIL FAX ~S~ y ~G ~
APPLICANT (If other than owner) _ _
(Applicant if other than owner, a statement aathoriziag applicant to act as agent for owner must accompany this applieatYOn.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home ( ) Work
FAX
Vo.1~01 P. 3
Cell ( )
CD~TRACTOR: ,~'I' ~~ t-~~ti'L~/.~s'-f S ~~
MAILING A17DRESS: ZS ,~2~ LY-~_ ~.~, CZTY ~- STATE~ZIP ~~ ~
~,,.
PHONE: Home# 3.S ~ - ~~zzS`~Work# e~i° ~ ~/~ Ce11# ~,~~=
EMAIL FAX
How many buildings are located on this property? y _ _.
Did you recently purohase tklls praperty`~ No Yes f yes give owner's Warne) ~ Eb t~vl I~
Is this a lot span"? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Farnily Residence, l
Aparements, Remodel, Garage, Commercial, Addition,
APPLICANT'S SIGNATURE, CERTIFICATION AND A[JTHORIZATION:
that I have read this application and state that the iz~formatioa herein is coacct and I swear that any inform
in hearings before the Planning and Zoning Commission or the City Courtrai for the City of Rexburg shall
with all City regttlatio>rAS and State laws relating to the subject matter of this application atxd hereby author
upon the above-mentioned property for inspections purposes NOTE: The building official may revoke a
pirovisioras of th 000 International Code in cases of any false statement or rrtisrepresernation of fact in th~
permit or~based. 1?e~it void if not started within 180 days. Permit void if work stops ;far 1!
Do you prefer to be cantaated by fax, email or phone? Circle One
Ete~~, ..
lt~f ~erJriuurry, I hereby certify
which may here ~ 'van by me
dl~ W comply
:prescntatives of the City to enter
it on approval issued nndcr the
ic8tion or~dn writ`4'']t the
WARNING - T3UTLDI~TG PERMI'T' MUST BE POSTED ON CONSTRUCTIGN
Plan fees are non-refundable and are paid in full at the lime of applieallon iteglnniag Jaxr~m
City of Ret:bnrg's Acceptance o! tLe piss review fee does not constitute plan approve
**13nilding Permit Fees are due at tittle of appIlcatlon** **Build)gg Permits are void if you cheek i
CITY:
06 00010
3784 W 2000 S-Mad. Co. Mech.
~~
AN 0 ~ 2006 ~' ;
J~
clear**
~~n, 3. 2L~06 12,1~P~1
Vo.1~01 P,
~~:~Se CQ1IIj3~CtC t~le elrltll'@ ,E~~ij?11Cc`1tlUII ~ Yf the ciuesfion does not apply fill in NA for non
• . 'applicable
NAME ~ U~ c/
PRQPERTY DRESS T ~~'~ao~~o ~ ~ Permit#
SUBDIVISION
~GI~ZI~~'~l~ll i
.1V~IE~A.1ITICAL
F
Mechanical Contractor's Name: - Business Name:
Address ~~~~ ~ ~ b O y S~ . xty ~ - ~ - State Zip ~ s~~ o
Contact Phone: ( ) ~ S ~ -- ~~ ~ ~ Business Phone: ( )_ 3~ ~ •- ~ ~ ~ !~
Enxai] Fax
Mechanical E$lamate ~ (CommerciallMulti Family Only}
FIXTURES & APPLIANCES COUNT (SingYe Family Dwelling Only)
Furnace _ Exhaust or Vent Ducts
Furnace/Aiu• Conditioner Combo ~~ Dryer Vents
Feat Pump ~~ ~ 1 / ~s
Air Conditioner `~ `b~ 1 `n ~~ ~ ~ ~ 'C~5"
Eva rative Cooler ,1~
k?° ~,r
Unit Heater ~ V'1 ~`~ ~~r 4t`~~1~ ~ & ducts:
~' ~1~
fi 1 G~
Space Heatex , ~~'J
~„~ Decorative gas-fired appliance ~ ~I~`
Incinerator System (~ ~~
Boiler ~ `~~~ _
Pool Heater ~~ ~~ ~ ~~
Similar fixtures or Appliances J v `~~ Ck~ 1 " ~~,,.!~ w~, ,
Fuel Gas Pi Outlets includin s-,~,\` W ~~ c~v ~a ~~ , v~
~ g -`1~~~~a ~ g1ttOP
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) ~ Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
/ _ Point of Delivery must be shown on plans.
Contractor License number Date
.The City of Rezhurg's permitfee schedule is the same as required by the State of,ldaho