HomeMy WebLinkAboutBP & APPLICATIONS - 06-00327 - 484 Maple Dr - Mechanicalz
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JUN-27-2006 TUE 02:50 PM FIRST CALL JEWEL
CITY OF RE~IJRG
MECHANICAL PERMIT APPLICATION Pl
19 E MAIN, REXBURG, ID. $3x40 Yf ~
208-359-3020X326
FAX N0. 12085292793 P. 02
06 00327
484 Maple Dr-Mechanical
PARCEL NUNIDER: ~~ (~ (~'?~ ~ ~ ~ ; ~ (W @ will provide ibis for you)
SiJBDIVISION: r_r 7-vrnT~ BLOCK# LOT#
(Addrass~ng is based on the i>uuformation - must be accurate)
PHONL #
PROPERTY ADDRESS: ,1~~~ `~ ~ /1il
PHONE #: Home ~D ~"` - ~ 'GV'ork ( ) Cell ( )
OWNE12 MAILING ADDRESS: CTTY: STATE~2IP;-~~~~~'7""
EMA1L FAX
~PPLIX'A1V?_: (IF other than owner)
(APPltaanc 3f ether ti~en awes, 8 ~t enithot~lzing AppUcatlt to act a8 dge~t for owner moat accomP~Y this oapPlicatiou.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; ZIP EMA.lY. FAX
PHONE #: Hacae ( ) Work ( ) Cell ( )
/fin ~~r 6~
MAILING ADDRESS: ~ ~ ITY - ~TATEZIP ~.~ U
PHONE:I~ome# Wark# ~~~ ~77+Cel1#
EMAIL FAX ~~~.~...~ ~/r9'3
How many buildiu$s are located on this pmg~rty?
Did you recently purchase this poroperty? No Yes (1f yea givo otivnc~ 9 name)
Is this a lot split? NO YES (Please Erring copy of new Icgal dosaiption otPprppetty)
PROPOSID USE:
(3.e., Sitt~le Family Reaicienea, Mi~ltt Family, Agartmoats, RemocleJ, Garage, Commea~cial, Ac3ditiao, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHOR,I7.ATION: under ley aen~~. t Eby ~ awe t t,a~e
read>sda applbea:ioa mid ~ that tttc iudoattadoe been ie ennsrx. and I se+Qec tlm a~ ed'ormatiea wla~ n~'t,oroaner Ae dvdt b9 tgel0 heerln8e bdbsv t6o Plama+><
sea Zoeiae Coe~giaelal or the qty Couooil tax the etry a1RA0><burg abell bo wfh>b) ~d oo0noot. I ~m oonq+ly w1d, alt CHy regalaelaes and 9tae0: laws rela:mR to wa
cebjact ms~r o4lhds appliwien aed hcieb9 assttrorixed ropaoamAsAiveo ofl6o City to atoer upmi Ilse abow~wtlot~cd PttsDOtly for bupa~tlens t~ NPO'IS: The
hcUQlae otRolpl t0agy ravoks a paemit oa a~tnvai loafed aador the ysvrisiavit ePdr 20003 Ismneaiamal Gods u waoe adesn tisL7e atu ar ~ oYfeot fa
tho ~ptioatia~ eras We pleas oa whleh tho parnot of was bApd. I'+enel[ void b°nat stetod widdp 1 SO dgya. Pecmit vptel ~wes90: smpa £ar 180 days.
/ ~
51~etuto ot'Own~/Appltcam DAIS
Do you pier to be vow by Sx. email or pio~e? Clrale one
w,t,RNntNG ->nm.Dnt{c mun' sd oN cbtt~acriox snit
Ales ilea ere ~ sad Ara paW la Ifsil utbe Hasa of ap~ots tt~epeaio8 Jm®rmv I.3t7AS~
CSLy of Ressbuet'e Asx~aeoe o! the y/ao twlew lee doa.aiet oeafgptta plop a0p'ovd
JUN-27-2006 TUE 02;51 PM FIRST CALL JEWEL
May. Itl, LUUD IU;L4HM •
FAX N0, 12085292793 P, 03
iu o, (I 4 U r, 4
' ,~1~'dC~COI11plete t~1e enure AppliCatiOn! Ii the qucetion dace not apply >Gll in NA for non
applicable
NAME
PROPERTY ADDRESS p~~
SUBDIVZS~ON
Requrr~edll ! 1~~'CI ~AIITICAL
Mechanical Contractor's Name: ~ ~~ usiness Name: ~ C~~f'
Addresa_~~p /I/p'j~f ~~~~~~ City State zip~~~
Contact Plwnc; (~~ , 5~~- - ~ '7 7,,,' Business Phone: (~n~' ~~ ~ -~'7~ 7
Email Fax ~"~ ~- ~ ~~ 3
Mechanical Estimate S ~ G ~ .Conutt®rcixUMisuti Faintly Only)
FI~YTURES dE APPLIANCES COUNT (Si>ygle FaniiXy Dwelling Only)
Purnaoe Exhaust or Vcnt Duc~ta
Furnace/Air Conditioner Comho
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Dryer Vents
R.angc Hood Vents
Cook Stove Vents
Bath Fan. Vests
other similar vents &~ ducts:
.~,~..~
Space Heater
i,- Ikcozativc gas-fired app]iancc
Incinerator System
Boiler
Pool Heater
Similar fi~ctures or Appliances
Fuel Cras Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas OiI Coal FirepI~ Electric
Mechanycal Sizing Caicul~tfon~ must bo submitted With Plans & Application
Point of Delivery must be a-hown on plans.
i~ ~ ~ 7 D ~
ignaturo of 1.io ConOcactot Licoaao nambor Pat
~. .
__ _ The Ctty of Rexburg's permttTee sehMttle fs the sane cs re9u~rad' by the ,fie vJldaho