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HomeMy WebLinkAboutAPPLICATION - 06-00063 - Brookside Village #301 - MechanicalFeb 08 06 03:09p • p.2 ~C`I~ OF REX$URG PERMIT # BUILDING PERMIT APPLICATION Please complete the entire Application! 9 E MAIM, REXBURG, 7D. 83440 If the question does not apply fill in NA for non applicable --- 208-359-3020 X322 ,p~ ~` p ~~~ PARCEL NUMBER ~~~ bsd~~e lX ur' We will provide this for you) SLBDIVISION: UN1T# BLOCK# LOT# (Addressing is based on the infotattatioa -mast be accurate) CONTACT PHONE # PROPERTY ADDRESS: PHONE #: Home (. s 3 rya - Work ( ) -- v Cell O~rivER ivtAiI,ING ADDR SS: CI;~': - STATE. ZI?: - EAR, FAX APPLICANT (1f other than owner)- (Applicant if other than ovrner, a statement aLainorsnttg appncant to act as agent for owner mnat accompany this application.) APPLICANT INFORMATION: ADDRESS CITY: STATE; _ ZIP EMAIL PHONE R: Home ( ) Work Cell ( ) CO1VT1eACTOR: mn~r1 J~'1C' _ MAILING ADDRESS: ~2c! W - I'S~ ~ . CTIYT~{, a.01~ 1-c„t ~5 STATE ~ ZIP a3~O G PHONE: Home# Worlc# SZ,Z :~7Z Cell## EMAILS~+~U How menu buildings are .. FAX ~~~ - 21 I S on this property? Did you recently purchase this progeny? No Yes (If yes hive owner's name) Is this a lot split? NO YES (Please bring copy of new legal description of property) ptanonc>:n tle>;• (i.e., Single Family Residence, Multi Family, Aparnnen[s, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT' S SIGNATURE, CERTIFICATION AMID AUTHORIZATION: Under penalty of perjury, I hrreby cetify that I have read t6:is application and state that the information huein is corrtct attd I sweet that any u-formatioa which may ben:aRer be gvEn by me is hcarmgs before the Planning and 7.oaixtg Commission or the City Council for the City of Rexburg shall be truthful and eotreet I agree to ComDIY witJt a[I City rcgulariom and Stato laws rtilating to the subject tnBtter of this applicatioA apd herelry authorized represcatativcs of the City to earls upon the above-mentioned property for inspections purposes. NOTE: The building official mrty revoke a pe;[nit ota approval issued under the provisions of the 2000 Intematioaal Code in cases of aoy !'else statement or misrepresentation of fact in the application err on the plans on which the permit or approve! was tlaac~ Permit void if not slatted within ! SO days. Permit void if work stops for 180 days. Signatwe of Owner/A licant DATE --~ r, ~ '. Do you prefer to be contacted by fax rinail or phone? Circle One . "~"~"~-- ~ ~ _ ~ j WARNIl~TG - BUILDING PIERMTi MUST BE POSTED ON CONSTR1tICTION ~ `' ~ ~ CTa l !,~ Plan reea are aoo-refundable and nee paid in i4D at the time of appUeatlon beg{aaiag Iair S. ~i, '.. City o! Rezbnrg's Acceptance of the plan review fee does not comtitute p1a0 approv •'~t 2006 ~, '*Bai{ding Permit Fees are due at time of applteatlaa"+ ' *Huildmg Yertaits are void if yon aback m L..-i , FAX Feb 07 06 04:58p p.2 Please complete the entire~plication~ It• the q••--~--- ~---- -~--'° "r~' n:_ "'" ''~~ ~°~ applicable w U11~63 NAME ~ ©0 5 ~ ~ ~ • r ° Brookside Village #301 PROPERTY ADDRESS t}$~ s 3 r~~~ :~~;rc~-- b SUBDIVISION Furnace Replacement Requited!!! 1tlECHANICAL Mechanical C``'ontractor's Name: l~OY1CtY1 •Tr~ G Business Name: Address `i' Z~s W , 1~~' S~ • City ~ ~o ~'c~-l ~ s State Sd Zip L~ 3402 Contact Phone: (~ ) 5 Z 2 -3 3 7 2 Business Phone: Email L'a~ a.n h J U c~ cc~bf e 0 h e.: n ~-i Fax 5 Z~ - Z. 11 S Mechanical Estimate S __ (CommerciallMutti Fatuity Omly) FIXTQRES & APPLIANCES COITIVT (Single Family Dwelling Orly) Air Conditioner Space Heater Bath Fan Vents Range Hood Vents Boiler Cook Stove Vents Decorative Gas Fireplaces Dryer Vents Evaporative Cooler Exhaust or vent ducts Fuel (gas) piping fixtures or appliance outlets y. Furnace \ 1N ates~ he.cLt ee- Cornb~ Furnace/Air Conditioner Combo Heat Pump Incinerator Pool Heater Hest (Circle all that apply) ~ Oil Coal Fireplace Electric Unit Heater Mechanical Sizing Calculations must be submitted with Plans 8c Application Point of Delivery must be shown on plans. NVC-C-1512 Z1'~ ~o~ Sienaturc of Licenszd Contractor I_icen•:: rannbcr Date Recli~ired? The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 5 Feb 08 06 03:09p . Feo. 8. 2u06 1:59P41 ~ (d o.lo~4 ?. ~ Please complete the entire Application! ~ tltie ~~est;on ao~s not apply fill ;n NA ror tton applicable NAME 1 ~(~~~ 1 `a ~ ~ ~" ~~ 1 PROPERTY ADDRESS 4-8~ s ; o w ~ex~;x,,~~ Permit# SUBDIVISION p.3 ~equiredll ! M~C.~~A.N~~CA.~ Mechanuca"l~Contractor's Name: 3re~'1~ ~nan Business Name: ~OYI~ri I y1 c Address_ `-i' 2~ ~ f ~ ~~'' ~ , City ~ cap o ~-~ I ~ ~ State ! cJ Zip ?33 Q Contact Phone: ( )~ SZZ.- ?~~_~_~_ P„siness Phone: ( ).. ---„---- ---- _----- Email C6nC.w~1 nyc~ - c;~hlzn~ ~, , ~~} Fax SL~i - 21 IS Mecbarucal Estimate $ 5; ~-l ~'-~ 2`-' (Commercial/Mnlti Family Only) FFXTURES ~ APPLL4IYCES CDU~VT (Single Family Dwelling ©nly) ~^ Furnace \ vJA~,~ heoa~-- ~~bo Exhaust or Vent Ducts Furnace/Air Conditioner Combo Dryer Vents Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas-fred appliance Incinerator System Boiler Pool Heater Similaz fixtures or Appliances Fuel Gas Pipe Outlets including stuboed in or future outlets inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) ~ Gas Oil Coal Fireplace Electric other similar vents ~ ducts: 1V;(echanical Siziag Calculations must be submitted with Plans & Application Point of Deliver3- must be shown on plans. Signature of Licensed Contractor The Ciry ofRexburg's Range Hood Vents Cook Stove Vents Bath Fan Vents uvC-~i -f5i2 License number fee schedule is the same as Z~ 1~~Dlo Date by the Srate ojldaho