HomeMy WebLinkAboutAPPLICATION - 06-00053 - 8095 S 200 E - Gas Linen ~~,-, ~r,~~ -r,.., bra '7faflG 1 1 •'7Z~M P~/3
FROM :DIAMOND HEATING ~ FAX N0. :1-2P
C~h'Y OF REXI3 CIRG 06 0005 3
BUILDING PERMIT APPLICAT101V Pleas 809 5 S 200 E-Mobile Horne Gas Line
19 E MAIN, REXBUR(:a, ID. 53440 If the q
208-359-3020 lC322
PARCEL NL~MBER:_~~ ~ v~~~~~ =~`~Le will provide this fur you)
SUBDIVISION: UNlT#~_ BLOCIC# L01`#
(Add>cessing is based on the infoamation -must be aceura»e)
r- o CONTACT PHONE #~ ~ - - '-}a
PROPERTY ADDRESS;~~_~
PHONE #; Homy ( ) Work ( ~ Cali ~ ) _
,~
OWNER MAILING ADDRESS:~~~ CH'y;_ ~~SraTE:~2IP:
EMAIL FAX
~~!PJ1j~jT (If other then owner) - ---
(App.liennt if other tlisn owner, a ettttetnetu authorizing 1ieattt to act ao n~ent far owner meat accompgny thi9
AepLICANr INFO~1vrATzoN: ADDI~ss-- cITY:
STATE; Z1P ~p~, F.aX
PHONE #: home ( ) _ _ Work ( ) Cell ( )
MAILINC3 ADDRESS: 1~3 ~ CITY STATE„ZTPY3 ~/5~
PPIONE: Home# - `~ Work# j~_-~q~ Ce]1# - ~
EMAIL = _,..~...F~..d~Q~~, ~~~ `1,~.~j
v ,._.,.
Did you recently purchase this property?~i Yes (lf yes give owner's name) "
is this a lot split? 'YES (Please bci.ng wpy of new lags! deseriptian of property)
PRpPOSED USE: a 1 Yl OVY~~
(l.e., Single Ft~ly Iteeiderlte, Multi Fttrnily. Aparlmenta, ~2emodel, Game, Cotuitercial. Addition,
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby arat"ify
that I haws read this application aad state that the iaR~rmation herein is aarrect and .I swear that any laforrnation which may 2sereaflsr be given by me
In he~lrigs before the PJtolniag asld Zoning Co;~tmission or rise C)ry Couneii fur the City o! Rex[nu~ 9lm11 be trlrthful and con+oC!..! aStoe i4 comply
with all ~Y ro~uiationa and 5fs~te laws relati,ag to tiro subject rustler of tFis applirotion and hereby authorized renutsentstives oP the Clry ro ertrr
upaa- the shove-met-tlot-ed property for lnspeotlons purposes. NO7Er The building oSflcial may revoke p pettnit on approval iesucd under tltie
provisiame oPthe 2000 httcmatioael Co ae of any t'alse stetemarri or tttisreprrsesttatioa of fisct in the application or ou the pia on which fbc
t or• rovsi w~„besed.._ - ~erid if t• stm~ted within 180 da a Pcnrtlt void !f wort era s Por !80 4
_~.~- _ _. Y p ays,
of Owner/A D ~~~-~
Do you p>tefer to be contacted b fay; email or phorte? Circle One
WARI~TNO - S G PICRMIT MUST $'E PQBTlED pN CONSTRtTCT10N SITE!
PI^n !`a stye naa-refuadable att~r~,~,~Il~tt1~~+~,E~~ ere ~ u
- -- --- - --- - yo C~6eoic t30e6 nut elear*
FROM :DIAMOND HEATING ~ FAX N0. :1-208-522-7933 ~ an. 30 2006 11:22AM P2/3
.pail, ~i~ t'~~!~'1 ''I•!~~q!~~ '. ;;
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Please complete the entire Application! tithe y~tton aa~ not ~ppiy ru,n lv'a rur noo
appUcable
NAME ~=• r L(+~
PitOPERrY ADDRESS _ D0~ U ~ ,~ p~i~
SUBDIVISION
Required!!!
MECI ~ANICAL
Mechanic4i Contractor's Name: ,y~~' ,~ ' QY Business Name:
Address_~.--~-~ ---CIt3'~~j~,State.._ ___. Zip~~
Contact Phone: ) - ~~__Business Phone: ~~'f ~~~~~~'
Email ~ _. _
Methaniieal Estimate $_______,,,_, (ComtuerciaUMulti Family Only)
FIXTITR~'S ~ APPZIAIVCES COUNT (S~»g1®Far~rily Dwelb-~eg Only)
Furnace _~ Exhaust or Vent Ducts
Futriace/Aix Conditioner Combo
Feat Pump
Air Conditions
Evaporative Cooler
Unit .Neater
Space 1~Ieater
Decorative gas-fired appliance
Incinerator System
$oi]er
Pool Hester
_ Dryer Vents
•~,,,, Range Hood Vents
__„___ Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Similar fixtures or Appliances
Fuel O~as Pipe Outlets including stubbed in or future outlets 1 ~~~~ ~ C,c~S ~ 1 ti
,„~_ Inlet Pressure (Meter Supply) PSi -~ 1~ 1~ 1LJ~~-~~~ ~'~
Heat (Cycle all that apply) (Gras) Uil Coal Fireplace >+lectric ~' ~ ~ ~ ~
Mechanical Sixiag Calculations muffit be submitted with Plans & Applieatioa
Point of Delivery must lbe shown on plans.
Sl~na'e mr C.ieenae numbtr
Tha City of Rerbtrrg's permit fee sc~cfule u th® some a~
she Sfa~e of Id~iho