HomeMy WebLinkAboutBP & APPLICATION - 06-00263 - 350 Salem Ave - MechanicalZ
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CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
PERMIT #
If the
PARCEL NUMBER:
SUBDIVISION:
(Addressing is based on the information -must be accurate,
Ob 002b3 able
350 Salem-
Furnace Replacement _
OWNER: _ ~ %~''~ f'c'A~ ~~, ~.~ ~ u ~'.i ;~ CONTACT PHONE #
PROPERTY ADDRESS: .S /~~~~'^:1r1 ~, ~~_~,~ ~~,.I~j
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS:
EMAIL
CITY:
FAX
STATE: ZIP:
~~
APPLICANT: (If other than owner) ~'I~ ~'j ~ ~n --~' ~ ~~~ ~ ,-tip
(Applicant if other than owner, a statement authorizing applica t to act as agent for owner~t accompany this
APPLICANT INFORMATION: ADDRESS-pp _ ~ CITY: 7~~~t~ ~~ ,
-_~
STATE; ZIP ~.~~pEMAIL 1~/~-- FAX~2~)
PHONE #: Home (-~~ ~.{~ Work (~„~~~-~i~0 Cell
CONTRACTOR: ~~~~i
MAILING ADDRESS: CITY
PHONE: Home#
EMAIL
Work#
FAX
Cell#
P
CITY OF REXBURG
How many buildings are located on this property?~~ ~.
Did you recently purchase this property? No es yes give owner's name~~~t~'~~~ j,~l-{T,~~~ ~~--
Is this a lot split?~~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ~c+-~~ ~,,~ ~1~1~i ~ ~ ~~~~~
(i.e., Single Family Residence, Multi Famil AyFamil partments, Rem del, 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 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.
ier/Applicant DATE
Do 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 January 1. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
PIeASe COI1lplete tale Clltli'C AppI1CAt10Il~ If the question does not apply till in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! steMECHAAe NICAL
~T-
Mechanical Contractor's Name: ~ i ~' ~ °I- Business Name: ~ ~,
Address --~~ ~X !~7 City _ - State~~ Zip
Contact Phone)_ ~" ~ l ~ Business Phone: (?.~j ~~- "~j t~
Email
Fax ~~ ~`~' ._
Mechanical Estimate $ (Commercial/Multi Family Only)
IXTU~S & APPLIANCES COUNT (Single Family Dwellin Only)
I // 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) Gam 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.
Signature of License Contractor
The City of
License number Da
schedule is the same as required by the State of Idaho