HomeMy WebLinkAboutBP & APPLICATION - 06-00376 - 4300 N 2000 W - New SFR MechanicalZ m ~ ~•r
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CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please c
19 E MAIN, REXBURG, ID. 83440 If the quest
208-359-3020 X326
PARCEL NUMBER: ( ~
SUBDIVISION: _ UNI
(Addressing is based on the information -must be accurate)
PERMIT #
•
-- ~ -~- LL A Af~~1~A A >n>nlir+sttinn ~
os oo37s
4300 N 2000 W-County Mech
OWNER: ~ic. ~,~zz~c~ CONTACT PHONE # 3i3- yS `~ ~
,~~
PROPERTY ADDRESS: ~~~ A/~ ~,n,~, ~,,,
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: ~~~p,4/'. mow . CITY: ~ STATES ZIP: S3Y~a
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 CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR: A~ 1 1~J
MAILING ADDRESS: 3~2 - .> ~/, CITY ~ y-c,~, STATE-~.V ZIP ~.35/Ya
PHONE: Home# Work# Cell# 3s'7- 2 S 3 3
EMAIL FAX
now many nullamgs are located on this property'? C~i11
Did you recently purchase this property? Q~o Yes (If yes give owner's name)
Is this a lot split? ~~ YES (Please bring copy of new legal description of property)
PROPOSED USE: S/~//l,. (F ¢ ~ ~, ~~3 ~,,~ Ls~~-
(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 corcect 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/fwhjich the permit or approval was based. Permit void if not started within 180 days. Permit void i°~f work stops for 180~da~ys.~
Signature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email o h ne Circle One
WARNING -BUILDING PER UST 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! it t~ question ace., not App~r flli in 1vA fog non Applicable
NAME
PROPERTY ADDRESS tf~~.of,~ ,2v~~ i.,>.
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~ , F- .5,~~~p.~(,~, Business Name: ,~ r ~ ~~~ ~;, ~,~~
Address 32 ~~ ~~- ~~~, ~,, City '~,~ ~„r-:~ State -.~~(4 ~ ~ Zip ~'7~~
Contact Phone: (2r,S) 5i,3 - a~ a ~, Business Phone: ( )
Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace ~ Exhaust or Vent Ducts
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
Range Hood Vents
Cook Stove Vents
.3 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) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
lz~~~
Date
The City of Rexburg's permit fee schedule is the same as
the State of Idaho
Fax
Signature of Licensed Contractor License number