HomeMy WebLinkAboutAPPLICATION, BP - 06-00043 - 4701 Juniper Ave - New SFR MechanicalZ
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City of Rexburg/ Madi~County PERMIT #
BUILDING PERMIT APPLI ON ~ 2i~ F~~~.; =•4,a~il ~- ~~z~-~: ry~~$ ~3 ~~g,~~, ;• F .,~,,.... ~ g..3_
19 E MAIN, REXBURG, ID. 83440 # ,' a: ~ ~~~ e ~.~:3:
208-359-3020 X322 Ob 00043
PARCEL NUMBER: DCi~`~ ~~'~~ ~ (~ 4701 Juniper Ave-County Mech.
SUBDIVISION: C ~ ~.~- -- UNl
(Addressing is based on the information -must be accurate)
~ONTACTPHONE# USX --$~40 `~39-Khoo
PROPERTY ADDRESS:
>. ~~ ~~ ~~J~~J
PHONE #: Home (~) '`~ S~ ° v ~ ~ ~ Work ( ) Cell ( )
OWNER MAILING ADDRESS: ~S ~ 1 ~ b `~ i~ CITY:~~e-~ ~~i STATE- n
EMAIL
FAX ~ ~ ' ~ ~ `'~
ZIP ~ ~ ti. ~+, ~
APPLICANT: (If other than owner) -
(Applicant if other than owner, a statement authorizing applicant to act as agent for ow[(n~er m~([,t~accosn plication.)
APPLICANT INFORMATION: ADDRESS I! U I ~ CI r ~ ~ I l
STATE; ZIP EMAIL ~ ~ Qq 3 2Q06
PHONE #: Home ( ) Work ( ) I Cell
CONTRACTOR:
MAILING ADDRESS: ~~ ~ o~ ~ CITY ~~ ~ STATE~_ZIP d 3`1~ 1,
PHONE: Home# Work# Cell# `~~-- `Z6S~
EMAIL FAX
How many buildings are located on this property?,
Did you recently purchase this property? No es (If yes give owner's name) ~~~~ r~ '~'~~'• S t S
Is this a lot split?CNd~ YES (Please bring copy of new legal description of property)
Single Family Residence~ulti Family, Aparhnents, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I
have read this application and state that the information herein is correct and I swear that any iafonnation which may hereatkr be given by me in hearings before the
Planning and Zoning Commission or the City Can~il far the City of Rexbwg shall 6e truthful sad axrxt. I agree w comply with all City regalatans and Stye laws
relating to the subject matter of this application and hereby authorized representatives of rho City to eater upon the above-mentioned property fa• inspections purposes.
NOTE: The building official oke a permit on approval issued under the provisions of the 2000 tntematiatai Code is cases of any false statement a•
misrepresentation of fact in plieation 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 days.
Signature of O pp tcant DATE
Do you pre • to be contacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Pion fees are non-refundable and sre paid in full at the time of applieation beginning Janua~v 1.2005.
City of Rezburg's Acceptance of the plan review fee does not constitute plan approvab
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~~~C~lS~ t;t)iil~)~~~~ ~~1C ~It~~ fg4~J~3~IC~k~:lOlCtt T#'the +:~uestioaa ~1~iot a~~~~ly' !'iti iit TrT<!. t®~° uan
' applicably. ~
NAME ~~n ~` ~ ~`'""' C
PROPER ADDRESS ~ ~ ~ c:c ~~~ ~ ~ Permit#
SUBDIVISION ~,`, r ,~-
~~ ui~er~!!! MECHANICAL
j~, c~ / j
Mec 'cal Contractor's Name: ~'~ ~ 1~,~-~~ ~ C~ ^ usiness Name:
~O (~` ~ ~ Ci ~ State `~-~~ ZipsCC x(`12,
Address 1 ~ t3'
Contact Phone: (J ~~) 7~ `~ - `~ ~ S o Business P one: ( )
Email
Fax
Mechanical Estimate S~~ (CommerciaUMnlti Family Only)
FIXTU S & APPLIANCES COUNT (Single Family Dwelling Only}
_~?G~urnace ~~ _~_ 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
Similar fixtures or Appliances
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas it Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
,~.. ~
- ~<<4 ~ ~J a 3~°~
Sig iaturc ul' Licensed L'~>ntract~r License number Date
Reyuirc:d!
Range Hood Vents
Cook Stove Vents
njr /~ Bath Fan Vents
The City of Rexburg s permit fee schedule is the same as required by the State of Idaho
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