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Home My WebLink AboutAPPLICATION - 06-00082 - 4464 N Salem Hwy - Mech.MADISOI~OUNTY BUILDING DEPARTMENT THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK rssue Date: ~~a~6 ~1~ ~~~~~ HEREIN INDICATED OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. Tl-is permit is issued subject to the regulations contained in the International Building Code dr Zoning Regulations of Madison County and i t is hereby agreed that the work to be done as shown in the plans dr specifications will be completed in accordance with the regu/ationpertaining andapp/icab/e thereto: The issuance of thepermit doesnot waive restrictive t GVYGIW! S Owner: ~~~- x I v Job Address: ~ t ~, ~ y~ Builder: - ~ ~.. ' ~r~'1 Architect/Designer: ~~ (l, ~ Phone No.: ~~~ - ~ ~~ Phone No.: Structure: New ^ Remodel ^ Addition ^ Repair ^ Renewal ^ Fire Damage Residential ^ Commercial ^ Educational ^ Government ^ Religious ^ Fence ^ Patio ^ Shop ^ Garage ^ Carport ^ Deck ^Shed ^ Agricultural Bldg. ^ Multi Family ^ Sign 0o i ou dation vase tia loos oncrete I ner ode oncrete Masonry oncrete Masonry ar Full D ~11A/ood p th Compliance oRoof ~Monolit is Footing ~ICF 4~lo er o ~ Floor oAll Weather Wood oUnfinished Finished x e io al s Interior Walls Ceiling o0o U Hea i i_ i, . ,~~ `' s oncrete ood oncrete ~M/ood ~ en ood pp w t ~1Nood Sh. h {~ u r ~ o0il cTy~~ ~ C l asonry (Veneer ~~Masonry -~D all Acoustic Drywall . J~Comp S Nile oa Fireplace Metal o oPlaster oTil Plaster Nile Sinnggle Ply Metal Electrical oOther Stucco e ~ aICF Remarks: Value:$ ®~~y-~ Fee: $ ~' .,~ - Check ~ Cash Applicant: Date: Inspector: s?~~_ Date: ~? ~~ b"" U U White- Owner Copy Canary -Building Dept. Copy Pink -Inspector Copy 6okknrod -Assessor Copy City of Rexburg/ Madis~ounty ~ 06 00082 • "' I~UILI~ING PERMIT APPLICA ON Please cU 19 E MAIN, REXBURG, ID. 83440 If the ~~tta~ 4464 N Salem Hwy-Cnty Mech. 20$-359-3020 X322 PARCEL NUMBER ,~ ~ ~ We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) CONTACT PHONE #~ j~ PROPERTY ADDRESS: ~.~ID~ ~ ~~~~ ~ p PHONE #: Home ( ) : ~~~~ 1 ~ Work ( ) Cell ( ) ~C - ~..~ 3 I ~~ OWNER MAILING ADDRESS:LI~1~}~ ~ ~Ieln QcICITY:j,~_STATE:~ZIP:~?L` EMAIL gl~utir" }~ n ~~rt~iti'5l•i~AX APPLICANT: (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner mast accompany this application.) APPLICANT INFORMATION: ADDRESS, CITY: STATE; ZIP EMAIL FAX PHONE #: Home Work ( ) Cell CONTRACTOR: MAILING ADDRESS:, ~CITY~ILI-Y~STATE I~ZIP ~ ~ PHONE: Home#~~t,v~~~~15 Work# Cell#~~i(1 -CIS e~- EMAIL Gii~r~ I~~bl~ti~~ S~.~AX --------- - --- How many buildings are located on this property? C~) Did you recently purchase this property? No 'es (If yes give owner's name)~Y`(~~~.. ~_ Is this a lot split? NO YES' (Please bring copy of new legal description of property) PROPOSED USE: ~~~ (i.e., Single Family Residence, lti Family, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have road 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 ~romply 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-mexitioned Property for inspections purposes. NOTE: The building official may revoke a permit on approval issued undo the provisions of the 2000 Intemadonal Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180,~ays. Signature of Owner/Applicant , -'"~-~~ ~ ~i"~ Do you prefer to be contacted by fax, email or hone?~. Circle One U ~~ WARNING - BUILDING PEST BE POSTED ON CONSTRUCTI SI~ r I Plan fees are non-refundable and are paid in fall at the time of application beginnin u 200 2~~6 City of Reaburg's Acceptance of the plan review fee does not constitute plan appro 1. 2 P~~?~iSC C()[ll~)~Cte ~~1C ~I1~ ~~~?~~~t14",i~t10~1~ t~'the cguestio~i dot apph~ CIi iii PdA tier ~-<~u zF~OIICdiZI~C NAME PROPERTY ADDRESS SUBDIVISION Permit# Re~uir~d!1 MEC~~~INICAL Mechanical Contractor's Name: /j'/ (~0~ ~~ 2 Business Name: ti/o e ~~ Address ~Ux /~~ City S ~~ C', 7'V State ~' - Zip Contact Phone: ( ) Business Phone: { ) ~~Q - ~~~9 Email Fax Mechanical Estimate S (CommerciaUMnlti Family Only) RES & APPLIANCES COtINT (Single Family Dwelling Only) ,,'Furnace ~_ Exhaust or Vent Ducts Furnace/Air Conditioner Combo ~ ~ Dryer Vents Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater ,~ Decorative gas-fired appliance Incinerator System Boiler Pool Heater ,~v--- „~ dents Cook Stove Vents E~ `~ .'Bath Fan Vents other similar vents & ducts: Similar fixtures or Appliances Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter~~Supply) PSI Heat (Circle all that apply) ~ra,~ Oil Coal Fireplace Electric Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. ~- ~ ~' , =- ~ ~~35. r z oS Signature ut~l,ice used Contractor License number Date Re i~ircdi i The City of Rexburg's permit fee schedule is the same as required by the State of Idaho