HomeMy WebLinkAboutBP & APPLICATION - 06-00387 - 3690 Mountain View Dr - MechanicalZ m ;3 ~Ir,.
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CITY OF REXBURG
PERMIT #
MECHANICAL PERMIT APPLICATION Please co
19 E MAIN, REXBURG, ID. 83440 If the question
208-359-3020 X326
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06 00387
PARCEL NUMBER: (We . 3690 W Mnt View Dr- County Mech
SUBDIVISION: UNIT
(Addressing is based on the information -must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS: ~ ~ 9~ /,(~'~h ~~,P; ~/^~~/zo - Q,G ~o s~° ~f tee] ;~
PHONE #: Home ( ) ~3~-~ -,6-~/~ Work ( ) ..35-x-~5"s'3/ Cell ( ) 3~,~/67~
OWNER MAILING ADDRESS: srr~mP CITY: STATE:_,QZIP: g3y,~d
EMAIL FAX
APPLICANT: (If other than owner)- .Sam ,~ as ~ ~~,~6, ~
(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: ~>
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
flow many bu><ldmgs are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name) ~j/^,bi ~/~,~~~l~!
Is this a lot split? N~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ,3,
(i.e., Single Family Residence,
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 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 applicatio~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.
i
ier/Applicant DATE
Do you p>~fer 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
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PjeRSe COmpjete the entire AppjiCatiOn ~ If tlse question does not apply fill in NA for non applkabk
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address
Contact Phone:
Email
1
Fax
Zip
1 Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
~_ Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
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
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanic$1 Sizin>~ Calcul$tions must be submitted with Plans & Anp1iC_, a„ won
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The City of Rexburg's
Business Name:
_City State
Business Phone: ( )
schedule is the same as
Date
the State of Idaho
MECHANICAL
License number