HomeMy WebLinkAboutBP & APPLICATIONS - 06-00328 - 95 Crest View Dr - FireplaceZ
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CITY OF REXBURG 06 00328
MECHANICAL PERMIT APPLICATION Pleas 95 Crest View-Mechanical `~
19 E MAIN, REXBURG, ID. 83440 If the q ~le
208-359-3020 X326
PARCEL NUMBER ;~i~~~b.iT`•. ~ ~(~ (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
PROPERTY ADDRESS: ~~`,~ G,~'~ ji
PHONE #: Home ( ) '~5~- -- ~~~y Work
CONTACT PHO>lNE # ~ j-
OWNER MAILING ADDRESS: ~~~~~-~ CITY:
EMAIL
FAX
Cell ( ) ~/J'~
STATE: ZIP:
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 CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR: c~Gi~~ /,lam - - ,~,
MAILING ADDRESS: ~%y~= Z~-,Z> ,,f,/ CITY ~'~ STATE /j.> ZIP ~ ~i'f~"c:%
PHONE: Home#~~~~ ~~"~~~ Work# Cell# ~,,~~fj'~
EMAIL FAX
How many buildings are located on this property? /"
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot splits 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 swear 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 applica ~ nand hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The
building official may r vo a permit on approval issue under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or on fans on which the perrp;~or proval was based. Permit void if not started within 180 days. Permit void~i~f~w,,ork stops for 180 days.
Signature of , caner/Applicant DATE
Do you prefer to be contacted by f ,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 queatiou aoea not apply fill In NA for oo^ applicatble
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MECHANICAL
,~ .~
Mechanical Contractor's Name: ~~ J ~'~ ~r)~/"/.5~~ Business Name: %~~
Address City State Zip
Contact Phone: ( )
Email
Business Phone:
Fax
Mechanical Estimate $ (CommerciaVMulti 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
~- Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Heat (Circle all that apply Gas bil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
f ~ Point of Delivery must be shown on plans.
Contractor License number Date