HomeMy WebLinkAboutBP & APPLICATION - 06-00258 - 166 E 7th N #40 - Mechanical
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CITY OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION Please complete the entire AuUlication!
19 E MAIN, REXBURG, ID. 83440 If the que
208-359-3020 X326 06 00258
PARCEL NUMBER: ~~'~ 'a~~'I~I,P ( 166E 7th N #40-Mechanical
SUBDIVISION: UI`
(Addressing is based on the information -must be accurate)
OWNER: ~i~ ~('~~~~~~~ ~ P ~~~CONTACT PHONE #
PROPERTY ADDRESS: I (~ ~ ~ `~ ~ ~ ~ ('~
PHONE #: Home (~)
OWNER MAILING ADDRESS:
EMAIL
Work (~) Cell ( )
CITY: ~I~ ~ STATE:~ZIP:1~~
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
STATE:
PHONE #: Home
Work ( )
CONTRACTOR:
ZIP EMAIL
FAX
MAILING ADDRESS:
PHONE: Home#
EMAIL
FAX
CITY:
FAX
Cell ( )
CITY STATE ZIP
Cell#
How many buildings are located on this property?~'+YL~--I~~~i l~ ~11'l ,p
Did you recently purchase this property? No es yes give owner's name)~~ ~ ~ ~~~ .l ~e ~
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: _~_~ ~l~ -~' -'~ 1',
(i.e., Single Family Residence, Multi amily, Apartments,
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 wit ~ regnlat;n„~ a„~ Sr~]au s rely
subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned p fo{~ sp on u~~se~~
building official may revoke a permit on approval issued under the provisions of the 2003 International Code in cases o se4l~late t ~istkpre>~nt a
the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. P ¢" ~ wor sops or ays.
_ _ ('~
Signature of Owner/Applicant ~1 " " DA
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTR C
Plan fees are non-refundable and are paid in full at the time of application beg' ni n
City of Rexburg's Acceptance of the plan review fee does not constitute plan appri
Work#
/~
~~
,~ •
~Pa~e~complete the entire Application! If the question does n`ot apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address
Contact Phone: ( )
Email
Business Name:
_City State
Business Phone: ( )
Fax
Zip
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL9NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
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 Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The
License number
's permit fee schedule is the same as
Date
the State of Idaho
MECHANICAL