HomeMy WebLinkAboutAPPLICATION - 06-00042 - 4518 Juniper Ave - New SFR Mechanicalz
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~~'Y OF REXB UR G •
~iUILDING PERMIT APPLICATION Plea 06 00042 ~n ~
19 E MAIN, REXBURG, ID. 83440 If the tble
208-359-3020 X322 4518 Juniper Ave-County Mech.
PARCEL NUMBER:~,~ "(~, ~ ~ ~ -
SUBDIVISION: ~~-r- ~ UNIT# BLOCK# ~ LOT#~
(Addressing is based on the information -must be accurate) ~-
OWNER NAME: CONTACT PHONE # ~ ~`6 - v (~ ~ J
PROPERTY ADDRESS:
~~
PHONE #: Home '~ v jO' w~ ~ ---'-~ _
' ~ Work (,--) 6-~~ ~l t~ Cell (-~.-'_
OWNER MAILING ADDRESS: a('N !1 ~~'hJ CITY: xi ~ STATE:~ZIP:~ 3`G~l ~
EMAIL
FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to
APPLICANT INFORMATION: ADD
STA
PHONE #:
EMAIL
Work
for
. CITY:
JAN
FAX
CONTRACTOR: ~ ~..~ ~- ~
MAILING ADDRESS: ,, `1 ~ CITY L ~ ~ STATE_~ZIP 3 -~ ~1
PHONE: Home# Work# ~/ Cell# `~ ~ - ~, (o
EMAIL FAX /
nuw inzuiy ouiiamgs are locatea on tnls property'! ;,L
Did you recently purchase this property? No "Ye If yes give owner's name) g ~ 1, ~ y~rv~,
Is this a lot split?~N01 YES (Please bring copy of new legal description of property)
`~
Family
Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify
that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me
in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply
with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter
upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions of the 0 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or app~~ was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
re of Owner/Applicant DATE
you prefer to be contacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January 1.2005.
City of Rezburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
Please complete the enti~Application ~ If the question doe~t apply fill in NA for non
applicable
NAME ,~ ~~~s~~
`~ ~ L- ~.-
PROPER~I'Y ADDRESS _ ~~~~~~~ ~,,,, Permit#
SUBDIVISION (`~ ~`~~,,,. {~~~
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~{~.,/~ ~~, ~ Business Name: ~~v-ti~~- ~~-bi
Address ~U U 72 City v State Zi
r
• _.__
Contact Phone: (L~~~ '~ ~`~ - ~~,,~ u ---
usmess Phone:..(.-------)-
Email
Fax ~`
Mechanical Estimate $ ~~.5`~~ ~ (CommerciaUMulti Family Only)
FIXTURES & APPLL4IVCES COUNT (Single Family Dwelling Only)
~,/ Furnace ~_ Exhaust or Vent Ducts
Furnace/Air Conditioner Combo ` Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler ~/' Bath Fan Vents
Unit Heater ~~~ other similar vents & ducts:
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
_~___ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
,~~ ,,
..~
Si ' ature of Licensed Contractor
The City of Rexburg's permit
'~) ~
~-rc~
License number
ilz3/~~r
Date
schedule is the same as required
the State ofldaho