HomeMy WebLinkAboutAPPLICATION - 06-00446 - 3333 W 2000 N - New SFR Mechanical_` ~ •
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C'ITY OF REXBURG
MECHANICAL PERMIT APPLICATION Pleas 06 00446 i~
19 E MAIN, REXBURG, ID. 83440 If the q 3 3 3 3 W 2000 N-Casty Mech Ie
208-359-3020 X326
PARCEL NUMBER: '~ ii
~~ ~ D~ ~~~1 ~ ~ (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: ,,C//ONTACT PHONE #
PROPERTY ADDRESS:_ ~3~~ GlI ~GYjO N.
PHONE #: Home ~~~ Work ( )
OWNER MAILING ADDRESS:
EMAIL
Cell ( )
FAX
CITY:
CITY:
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
STATE; ZIP EMAIL
PHONE #: Home ( )
STATE:
FAX
Cell ( )
CONTRACTOR:
MAILING ADDRESS: ,~?~Z_~~bx (~v?~ CITY STATE ~t~ ZIP 3~
PHONE: Home#o?o~-3,f9-i~~ Work# ?a9-f~6S0 Cell# ~1 ~ S~ .S'D
~d
now many nuuamgs are Iocatea on tn> 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:
(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 sweaz that any information which may hereafter be given by me in hearings 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
Work ( )
Cues ~
i
Please complete the entire Application! Ifthe question goes not apply cv ;n Na for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MECHANICAL
Mechanical Contractor's Name: u " ~ Business Name:
Address_ ~D . ljor ~a ~ Cit /~ ~~ ~'
y_~ State -L ~ Zip ~~ y~~
Contact Phone: ( ) ~~ ~ ~~' Business Phone: ( )
Emai l ~,cJ ~ .~ .SC' ,~. t `fax ~ ~~ Off/
Mechanical Estimate $ (CommerciaVMulti Family Only)
FIXTURES c~ 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
_~ Dryer Vents
Range Hood Vents
Cook Stove Vents
~_ Bath Fan Vents
other similar vents & ducts:
~_ Fuel Gas Pipe Outlets including stubbed in or future outlets
51 Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) as 'Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
~ ~ Point of Delivery must be shown on plans.
--
C~~~ L."
License number
schedule is the same as
'~`l
Date
the State of Idaho
The City of Rexburg's