HomeMy WebLinkAboutAPPLICATION, BP - 06-00445 - 1761 Clements Ln - New SFR MechanicalZ '~
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Sep, 11. 2006 1:OOPM • • No, 2673 P, 3
CITY OF REXBURG 06 00445
MECHAMCAL PERMIT APPLICATION Plea 1761 Clements Lane-Cnty Mech
19 E MAIN, REXBURG, ID. 83440 If the
208-35~-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 # 3 $'~ - ~~~t o
PROPERTY ADDRESS: / ~ (v~ ,~ ~ (,~~cr- ~- S ~,.~, ,,
irtvl
PHONE #: Home ~;~) ~~ ~- ~~`'t~Work
.~ ( ) Cell ( ) ' ~ 3 ~ --~-1,(,00
OWNER MAILING ADDRESS:_ ~S IL~C~ ~~L-J C1TY: J~STATE: 11'~ ZIP: ~ ~ `~ U
EMAIL FAX `'~ ~ ~-~ ~ ~ ~ ~
~4PPLIC,9]VT: (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
STATE; ZIP EMAIL
PHONE #: Home ( ) Work ( ) Cell
CITY:
FAX
__
ONTRACTOR: ~-Q ~; !.
MAILING ADDRESS: c'I 310 F ~ 6d N CITY~~,~ STATE~~ZIP ~`~ `1`1'~.
PHONE: Home# Work# Cell# ~'~°~ -(~,®_ ~q
EMAIL FAX .
How many buildings are located on this property?_ ~
Did you recently purchase this propt~ty? 10 Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of pr ~
PRO E:
(i. ,Single Fami esidertce, Multi Family, Aptirtrnents, Remodel, Garage, Commercial, Additi .) E
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: v derp ~~ have
read this application and state that the info[mation herein is correct sQtd 1 swear that any information which may herealler ~~lYl'~''
aad Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct, I agree to comply with 1 e ti d ret'aCing tpJlt~_
subject matter of this apptieation en hereby authorized representatives of the City to enter upon tho ttbovamrndoncd pro ecnons purposes. NOTE; The
building official may revo1:e it on approval isattcd under the provisions of the 20031ntemtttional Code in Cases of terry false staumeat of misrcpresrntetion of fact in
the application or on thy s an which the ptrmit or approval wos hosed Permit void ifnot started within 180 days. Permit void ifwork stops fbr l80 days.
r'"~~~
Sigoattu~ of wncr/Applicant - A~
Do v'o refer to be contacted by fax emt~il r honey 1 O
p ere a ne
WARNWG -BUILDING ERM ST BE POSTED ON CONSTRUCTION 31TE:
Plan fees are non-rehr ndable And are p^td i^ full ^t the lime of ^pplic.lion begiaaing lanaarv 1. 7005.
City of Rexbutg's Acceptance of the plan review fee dory not constitute plan approval
~+Sep.ll. 2006 ?:~~~,~I •
No. 26]3 P, 4
Please complete the entire Application! irtee question apes nor apply ml in iva for noo appn~abie
NAME ~~ G.-1 ~^-
PROPERTY ADDRESS ~ I S ~~ pe~~#
SUBDIVISION
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~ L, ~j Jl:,~i~~ Business Name: ~U,Ny~,~ (/(~~"/~/~,~f.
Address 'L3~~ (,(~ , 2(9~ SD City TL.~~ ~,~ State Zip g,~gq~p
Contact Phone; (~ ~- Q~~a Business Phone: ( ) _'351 - O ~7a
Email Fax ~S?' D ~
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4IVCE'S COUNT (Single Family Dwelling Only)
_ ~~~ Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo ~~. _ Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Hester
_ Space Heater
_ Decorative gas-fired appliance
Incinerator System
Boiler
pool Heater
o~ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
other similar vents & ducts:
Heat (Circle all that apply)~Gas> Oil Coal Fireplace Electric Hydronic ~f ° Pin e'
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shor~vn on plans.
^~ - ~ Q
/ 1 Sligna1tura of Licensed Contactor
The Ciry of Rexbur~'s
Range Hood Vents
`~ Cook Stove Vents
Bath Pan Vents
L- G-178
License uunnber
schedule is the same as
q-IZ-O
Date
the State of Idaho