HomeMy WebLinkAboutAPPLICATION, BP - 06-00237 - 3599 N 250 E - MechanicalZ
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CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
PERMIT #
Please cmm~tptp the a>n+~~-o A .,..~:,,~•.~.._,
If the quest
PARCEL NUMBER: Q1~ OS~I.I~~ I~ WI D ( W
SUBDIVISION: UNI'
(Addressing is based on the information -must be accurate)
06 00237
3599 N 250 E-Cnty Mech
OWNER: 7~nr T ~S~SY'~ts' CONTACT PHONE # ~ ~ ~~'S'7
PROPERTY ADDRESS: ~ S~J j n/` _ ~ ~-7J ~ .
PHONE #: Home (} 35~- ~~"~ Work
OWNER MAILING ADDRESS: 3~`i`9 "~~ ~~'
EMAIL
J~~ ~~~5 ~ Cell ( )
CITY: ~~:~ STATE ~ ZIP: ~~ ~YO
FAX ~ ~ ~ ~~-~ 7
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 Sij~~' CITY:
STATE
PHONE #: Home
ZIP _ EMAIL
Work
Cell
CONTRACTOR: ;T~~ ~t1, ~ ~~ ~77o.~v
MAILING ADDRESS: CITY
PHONE: Home# rl ~ Cell#
EMAIL
FAX
STATE ZIP
How many buildings are located on this property? 2
Did you recently p hase this property?~ Yes (If yes give owner's name)
Is this a lot spli . NO YES (Please bring copy of new legal description of property)
PROPOSED 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 sweaz 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 2003 International 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 days.
tore of Owner/Applicant DATE
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 Jauuary 1.2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
FAX
\~
Please complete the entire Application! if t>,e question saes not apply fill in NA for non applicable
NAME ~~'~~~' 2c f
PROPERTY ADDRESS 3..~ , ,N Z~ ~ ,, Permit#
SUBDIVISION
Required!!! MECHANICAL
Mechanical Contractor's Name: ~ ~~ /~~~ ~~ Business Name:
Address ~-~1~.~~ 2~`Z L-~',
_City ~X ~1/yZ ~, State.
Business Phone: ( )
Contact Phone: ( )
Email
Fax
~~ Zip ~~yYv
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES 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
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Pool Heater
_~ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply Ga Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor License number Date