HomeMy WebLinkAboutBP & APPLICATIONS - 06-00323 - 1512 Red Cedar Rd - New SFR MechanicalZ
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CITY`OF REXBURG
MECHANICAL PERMIT APPLICATION Please c
19 E MAIN, REXBURG, ID. 83440 If the questi 15 12 Red Cedar RC~-Crity McC~I
208-359-3020 X326
PARCEL NUMBER: ~~0~,~ ~ J ~ ~ ~~~~~% (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: ' ~ ~ CONTACT PHONE # '~
PROPERTY ADDRESS: ~ ~r ~F
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
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; ZIP EMAIL
PHONE #: Home ( )
06 00323
CITY:
FAX
Work ( )
•
Cell ( )
CONTRACTOR: c~ G
MAILING ADDRESS: ~ 2~/ ~ CITY ~ STATE~ZIP_~~Ci
PHONE
EMAIL
~ ~
Home#, G~,~Z Work# ~ _..~l~G~t~ Cell# ~~) ~ D >~, ~_
FAX `~_~~ ~b ~,'
now many bu><lctmgs are located on this 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:
(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) may revoke a permit on~pproval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the appli o the plan n whic a permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
S g tore of Owner/ pplicant 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
•
Please complete the entire Application! If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address
Contact Phone:
Email
City
Business Name: ~~ ~~'~J C~-~~
~,~/' - State Zip_~~~~~
)_ -~ 1 ~~ ~'/~ ~ Business Phone: ~-
Fax ~ -~-~ ~~ ~~ 2 ~/
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLL9NCES COUNT (Single Family Dwell' g Only)
Furnace ~ Exhaust or Vent Ducts ~vr~/C?,2 v~~,~
_~_ 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
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) as it Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~~~ ~ ~ ~
Signature of Licensed Contractor License number Date
MECI~ANICAL
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho