HomeMy WebLinkAboutBP & APPLICATION - 06-00388 - 1695 W 5350 S - New SFR Mechanicalz
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Please complete the entire Application!
NAME _~~ ~,( )
PROPERTY ADD S S
SUBDIVISION ~P.l'~
06 00388
1695 W 5350 S- County Mech
R Poaw ~ iav~e~l9v
~~
Required!!! MECHANICAL
Mechanical Contractor's Name: !~j P~ C Business Name: ~ ~~s ~Q l n
Address Zu~3 ~ • L(~ ~/ . City S-~• ~-}Ql`~~ State ~ Zip
Contact Phone: ( ) ID2~ 1~ -- ~ L((g ~ Business Phone: ( ) 3 l3-(PL~-1 G~
Email
Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwell' g 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
Similar fixtures or Appliances
Range Hood Vents
Cook Stove Vents
C ~ Bath Fan Vents
other similar vents & ducts:
3 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
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
pay 1 d. ~kd~
Signature of Licensed Contractor
The City ofRexburQ's
t I ~"
License number
it fee schedule is the same as
•
~- 3 ~-~
Date
by the State of Idaho
~ ~
CITY OF REXBURG
PERMIT #
MECHANICAL PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208-359-3020 X326
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS:
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
STA
PHONE #: Home
Work
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
nuw many ouuamgs are tocaiea on tnls 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:
ZIP EMAIL
(t.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 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 which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
/ /_
Signature of Owner/Applicant 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
CITY:
FAX
Cell ( )