HomeMy WebLinkAboutAPPLICATIONS & CHECK - 06-00037 - 2214 Robison Dr - New SFR Mechanical~'11'Y ~?~' REXB URG • PERMIT #
BUILDING PERMIT APPLICATION P1easE
19 E MAIN, REXBURG, ID. 83440 If the qu O~ OQ® ~'~
208-359-3020 X322 ^ t (~,
s~ARCEL NUMBER:'-Q(~~1 V ,`I~J~~~i~~ ~( 2214 Robison Dr,-~`O. Mech.
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
e
OWNER
PROPERTY ADDRESS: ~~~~ %~-e~s j-s ~l~/ ,~/l -
PHONE #: Home ~'35~."---~ 1~ Work (3ft~ - ,.~/~a Cell ( ).~`~"S'/- jS'~`G
OWNER MAILING ADDRESS`~i~~ 3c~e~ w CITY: ,~cX~S~t~' STATE:~ZIP: S~~-yd
EMAIL
FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home ( )
'ACT PHONE # ~.j% •%.S~`~
CITY:
FAX
Work ( )
Cell ( )
CONTRACTOR:
MAILING ADDRESS: /~~~/ ~~'%~ CITY ~X~C//L ~' STATE ~1~ ZIP~.~~~-
PHONE: Home#~.~-~~fl" Z--Work#3~0- ~/`a Cell# ,.~~ • ASS G
EMAIL FAX --
i ~~' ~.
How many buildings are located on this property? _ ~'
Did you recently purchase this property? No Yes (If yes give owner's name) /'U~ JA ~`~ ~ $ 2006 ,~
Is this a lot split~~ YES (Please bring copy of new legal description of property) Fay
PROPOSED USE.;
_..
(i.e.,ir"Family Residenc ulti 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 con•ect 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 2000 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approv was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
,- ~/ /G /~
Signature of Owner/Applicant DATED
Do 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 Rexburg'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**
.. .!~
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PlCase complete the enti a AppliCatiOn ~ If the question doe•t apply fill in NA for non
applicable
NAM>/ t4 l ~ ...~- jS~v~l
PROPERTY ADD SS o7 / % ~~~~ /J~ ~ Permit#
SUBDIVISION ,E,'pJZ , S ~ ~~~,~,~ ~~/~~~ ~
Required!!!
MECHANICAL
Mechanical Contractor's Name: ,~ ;,/~ ~I / I/~9---~-5 Business Name: Ditj~'/Orl/~~
Address__
~//~ ~ sT S~'~a~ city e ' u~ ~ State Tim zip ~yyo
Contact Phone:
Email
Business Phone: (~S'1~ ~.Sfi' 9~~~
Fax
Mechanical Estimate $ (CommerciaVMulti Family Only)
FIXTURES do APPLIANCES COUNT (Single Family Dwelling Only)
~_ Furnace ~ S ~ ~_ Exhaust or Vent Ducts W ~
Furnace/Air Conditioner Combo I ~ j Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
_~ Decorative gas-fired appliance ~ S"
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Range Hood Vents
~~
~_ 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
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
~s
r
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The City ofRexburQ's
License number
it fee schedule is the same as required
Date
the State ofldaho
.~
ROBISON CUSTOM HQMES, iNC.
PH: 208-35Cr0209
4301 NORTH 5000 WEST
RD(BURG, ID 83440
Pay to the ~ ~ `~~~ ~ ,~
Order of------ ,~~---_-`
~:
6449
92-41/1241
Date ~O 11,~~
of RIXBUR6, IDAHO 83440 l
For
o' L 2 4 ADO 4 L 7~• ~ 7 L L0 3 28 9 31I'-_ 49 .1'00000 ~ 4 500•!'
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State of Idaho
Division of Building Safety
Heating, Ventilation, and Air Conditioning Bureau ~~ C} ,~..~
1090 East Watertotiver,Street +~:,
Meridian, Idaho 83G42 ~ - _ 't.
MECHANICAL PERMIT APPLICATION~50.00 BASE FEE !'AID
HVAC BUREAU
BU LDERIOWNER INFOIt~t~ATION
Address:
'S .~_
New
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Supervising Jou
atnn. wt(r'rr•. AND \'fs1.1.0 ti' ('OPIIiS TO TOF, ISURGAU
KElil' P)NK COPT' 6qR YOUR R6:CORDS