HomeMy WebLinkAboutAPPLICATIONS - 06-00039 - 175 N 1st E - MechanicalC~1 Y OF REXB URG . PERMIT #
BUILDING PERMIT APPLICATION Please com lete t • ~ '
19 E MAIN, REXBURG, ID. 83440 If the uesN°-- p he entire Application!
208-359-3020 X322 `i
PARCEL NUMBER: ~~ ~ ~~~~ J~(~ 06 00039
SUBDIVISION: UNI 175 N 1St E-Mechanical
(Addressing is based on the information -must be accurate)
OWNER NAME: `' . ~. ~, ~ r
CONTACT PHONE #_ ,~,~ q
PROPERTY ADDRESS: / ~ - ,~ ft ~-
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS:_i ~f_ ~,~ ~ ~ r ~` CITY: ~tk,~, 4. STATE:.. ZIP:
EMAIL FAX ~ ~~~
APPLICANT (If other than owner) - /
(Applicant if other than owner, a statement authorizi g applicant t~ c ~ agent for~wner must accompany this application.)
APPLICANT IN~^FORMATION: ADDRESS_ ,3 ~ -~ ~ ~ --~~~ CITY: ~,
STATE; ~f ZIP ~,1y~~ EMAIL ~
FAX
PHONE #: Home (~,6)~~... ~~,~~ Work ( ) Cell
( )
CONTRACTOR: ~ ~ y ~ ~
MAILING ADDRESS: CITY
STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? Q
Did you recently purchase this property?~ yes (If yes give owner's name) .IAN Y
it
Is this a lot split?~ YES (Please bring copy of new legal description of p erty)
rROPOSED USE:
(i.e., Single Family Residence, 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 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 appr_ov~aliwas based. Permit void if t started within 180 days. Permit void if work stops for 180 days.
Signature of Owner/Applicant ~~;~" /_l r ~ / >~r«
Do you prefer to be contacted by fax, email or hone? DATE
P 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**
•~ .
Please complete the enti~Application! If the question does3ot a 1 fill in
applicable PP Y NA for non
NAME f - / ~ ~ /~` .>
PROPERTY ADDRESS i ~~ ' ,~,. s1~ Permit#
SUBDIVISION
Required!!!
Mechanical Contractor's Name: S %~-, ~ ~~ d'/~ .~ /~y+ . Business Name: .~t~, ~`~~/ 10%~ . ~i~
~'_~-_
Address ? ~ ~ ~ ~'~ City State Zip _? e
Contact Phone: (~ )_,3,-z- ._ ~ y~~ Business Phone:( )
Email
Mechanical Estimate $ ~J~r, ~ ` J (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
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
Fax
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~-~; " ~,
' ~~ " ~
Signature of Licensed Contractor
/~ 1~...
License number
/ - / 9 -~%~
Date
The City ofRexburg's
schedule is the same as required
the State ofldaho