HomeMy WebLinkAboutAPPLICATION, BP - 06-00535 - 7847 S 1800 W - MechanicalZ
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CITY OF REXBURG •
•
MECHANICAL PERMIT APPLICATION Please 1 06 0053 5
19 E MAIN, REXBURG, ID. 83440 If the ques
208- 359 -3020 X326 7847 S 1800 W -Cnty Mech
PARCEL NUMBER: 5N Mq ?�� X5L
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is b sed o the information -must be accurate)
OWNER: 1JEQ- nrr
CONTACT PHONE # elgr —
PROPERTY ADDRESS: 79 V7 5. 1 I,J ,
PHONE #: Home (/,M _ X 4 S7f(� Work ( ) Cell OO ,3J3 S
OWNER MAILING ADDRESS: CITY: e STATE -, - to(. Z I P:ff y�
EMAIL Grime 0ksIL 1_X
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,
CITY:
ZIP EMAIL
PHONE #: Home ( )
Work ( )
Cell ( )
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? 5 7 —
Did you recently purchase this property��es (If yes give owner's name)
Is this a lot splitcKoo 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 penalt of perjur I hereby certify that I have
read this application and state that the information herein is correct and I swear 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 o is 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 appl' ation r on the plans on whichA permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
FAX
/40 i ;�d i 4fp
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
a
Building Safety Department
City of Rexburg
19 E Main janellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
0Y 4EXBUQC
�o
U �
C I T Y O F
REXBURG
11-11, Americas Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Required!!!
MECHANICAL
Mechanical Contractor's Name: _ or K yAfj �r $usiness Name:
Address 79 3, 15 W , City eAlty' State :T&• Zip 'Vel
Cell Phone: (24 3 13 `OCR 3( Business Phone: ( cr6- J vs-
Fax: ( ) Email Aflq tP+r�Ch �tGl1:y /1bL
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
I 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
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Permit#
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Signature of Licensed Contractor License number Date