HomeMy WebLinkAboutBP & APPLICATION - 06-00250 - 176 S 1st W - MechanicalZ
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CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
06 00250
Pln~ 176 S lst W-Boiler Replacement ~n!
able
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: CONTACT PHONE # 3~ 1 • ?2 5,7,
PROPERTY ADDRESS: /
/ (7 ~j ` /~ ~~
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
STATE• ~ ZIP:
APPLICANT: (If other than owner)- ~,E~ ~~, ,~s. f ~~. ~;~ c,~
(Applicant if other than owner, a statement authorizing applicant to act as agent for o er must accompany this application.)
APPLICANT INFORMATION: ADDRESS T~~ ~ ~ ~~,~ CITY: ~X
STATE; / ~ ZIP ~c/ve EMAIL I~ , Q,u, ~,,, •~~,,,,,,~ FAX 3r-~ 8 z r~
i
PHONE #: Home ( ) ,? s -9 zi sz/ Work ( ) 3.1"< 6' s Cell ( ) ~i 3 ~Z J ~
CONTRACTOR: ~,,.,~
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
now many nuuamgs are locatea on tnls property'!.
Did you recently purchase this property? No Yes (If yes give owner's name
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: ~o.`~G, ~~~ ~~,,.i,~ •
(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 heazings 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 pl_an7 n which the pe ~ pproval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
,T /~/ .,~
DATE
Do you r 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
Work ( ) ~0/- ~o ~ ~~ Cell
CITY:
FAX
PIeaSC COI1lplete t]le//eRt1I'e App]1Cat10Il~ If the question does not apply fill in NA for non applicable
NAME (~s...~
PROPERTY ADDRESS ~ Permit#
SUBDIVISION
Required!!! MECHANICAL
Mechanical Contractor's Name: Business Name:
Address
Contact Phone: ( )
Email
_City
Business Phone:
Fax
1
State Zip
Mechanical Estimate $ pd (CommerciaUMulti 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
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
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.
~ '
ure of Licensed Contractor
The City of Rexburg's
License number
schedule is the same as
mil'. 2 O~
Date
the State of Idaho