HomeMy WebLinkAboutAPPLICATION - 06-00040 - 544 Partridge Ln - New SFR Mechancial~ar~~ 2'J. 2'J~~~ ~;3~~r~~~ ~~~, 149 P. ;
C~:i~'~ C?F RF~'.~'~TRG ~ PERMIT #
' Bt~ILD1~3G FER1`4IT APPLICATION ~''~ease eomplete the ei~trre Applicatian~
~ ~ MAI1ti, It,EX13C,YP.G, II7~. $3aI40 If the question does not annly fill In N.~ for non annlicable
208-359 jtI'2U X322
PARCEL N~CIMI3ER.: ~~~~ 1~(~G~ 06 00040
SUBDIVISION: ___ ~ ~-~ \ ~~(ew, ~ 544 Partridge Ln-County Mech.
(Addreiiszng is based can the infr~rmation - must'be accurate}
(~'~~~'~-~M.~': CONTACT PHONE #
P1~aPFRTY A1~I~1zESS:
PxavE #: Home (
O~TIVER MAILING .A.DDRESS:
ENTAIL
CITY: STATE
FAX
ZIP:
APPLICAIv'T (I~' other than owner) .._ . _.... ,
{~pplican3 if other than owner, a ~;taiement authorizing applicant to act as agent for ovvrter must accompauy this application. j
APPLICANT IIVFOI~.MATION: ADI3RESS
STATE; ZIP EMAIL
CITY:
P~IQt~~ #. Dome { )^ Work ( 1 Cell
.PAX
~ONfiRAf'T(3~: 1'S 1`i-'(~ ~ ~ "f',e~V2~f~ ~ - _---
MAILING AL~laR]ESS: CITY STATE ZIP
FIZDNE: I~orne# ~c-rk# Cell#
1rNIAIL FAX
Plow rnax-y btaild%r~gs are located on this property?.
i7id you recently purohese this property? No Yea (Tf yes diva owner's name)
is this a lot split? Na YES (Please bring copy of new legal description of property?
T'ROP45ED USE:
(i.e., Single Family Residence, Multi Family, Aparhnents, Retrtadel, Garage, CdratnerCial, .t3,dtiitiott, lrtc_~
~u~~.
JAN 2 0 2000
APPLICANT' S SIGNATURE, CERTIFICATION ANT] AUTHOT~.IZATION: Under prnalty ol'penury, I htrob;~ eettifj~
that I have read t>xis application sod state that too infotrnataon herein is correct and I swear that any irtfnxrxtaiao-t which .paay hereafter ba given by me
`try hearings before the irlatt,~,ing and honing Coenmissian or the Ci'rj Council for the City of Rexburg 3hali he truthful and correct. i t-pree to comply
with all City reguiatians and Stote laws relating to the subject matter of this application and hereby authorized rcprescntadvcs of the City to enter
upon the above-:ncntionod prnporty for inspections purpose3. NOTE; The bu+_Idiitg official may revoke a pertszit on alsproval issued under the
provisions oftlye 2~q4 ]nYerlnuttia.oa; Code itx cases 4~any i;'aPse statement ar misrcprescntation of fact in the spplit;ation or an the plans on which the
pcaanit ar apprQVS~I wa3 based. ~ennit void if not started within 180 days. Pemrit void if work slaps for 1$0 days.
_ _ _ ( I
Signature of Owner/Applicant DATE
Do yc+u prel'ex ca be contacted by fax, email or phone? Circle Doe
R'AR1YdN~'r - B'iJiLDING PERMTI' MUST BE POSTED UN CONSTRUCTIQN S17'E!
Plait fees are nen-refandabla and are paid ie ilttl ~t the time of application begianieg ~anuarv 1.300s~
City of Rexburg's Acceptance of the plan review fee dams not eonet>tvte plan approval
*"Bulldlbg lxermit .Fees are due at time of applicaEion~~` ~}Building Permits are void if you check dose not Clear""
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work ( 1 Cell ( ) "
II
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.,
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Jars, 2C+ 2GC6 9; 31~i~ No. 1544 F, 4
~IedSe CODIjJlete the en~e App~ICAt;iOII ~ If the question does no~a~pply ill fn N,A for nan
appllcabie
NAME ~ 1, C~~~- Sy Y `
Fl~OFEItTY ADDRESS Permit#
SUBDIVISION ~
l~e~ur~edl ~! 1VIE~H~ICA.~
Mechanical Contractor's Name: IIsincss Namc:
Address City State
Contact Phone: ( ) Business Fhone:
Ettiiail Fax
Mechanical Estvaaate ~ {Cammercial/Mnlti ~'amiYy ~~Y)
FilYTURES & AFFLIAIVCES COUNT (Stngde Family Dwelldng Oyt~y}
Z Furnace Exhaust or Vent Ducts
Furnace/Air Conditiaz~er Combo
Heat Pump
Air Conditioner
~„~, Evaporative Cooler
_~ Unit Heater
Space Heater
Z Decorative gas-fired appliance
Incinerator System
Bailer
Pool ]Heater
other cimtlar V~llt5 & ducts;
Similar fixtures ar Appliances
Fuel Gas Pipe Outlets including stubbed in ar futuxe outlets
inlet Pressure (Meter Supply) PSY
Heat (Circle all that apply} Gas Oil Coal Fireplace Electric
JAN ~ 0 2006 I
1VYechanical Sizing Calenlations mast be submitted with Plans & Application
Point of Delivery must be shown on plans.
Sigttattste of Licensed Contractor
The City vfRexburg's
l `(~ ~
License number
schedule !s the some as
20 ~ ~c~~
Date
the Strxte pfldaho
Zip
I Dryer `tents
,,,~„_ ltarige Hoad Vents
Cook Stove Vents
Bath Fan V eats