HomeMy WebLinkAboutAPPLICATIONS - 06-00536 - 1806 W 5350 S - New SFR Mechanical10/17/2006 07:58 2084584076 PAYS RACING LLC PAGE 03
UC t. ) I. ZHO i u jMV1 * • No 2994 P 2
CITY OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION 'lease complete the entire Application!
t9 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for nova applicable
209- 359 -3020 X326
PARCEL NUMBER (We will provide this for you)
SUBDIVISION: UNIT - -- BLOCK# LOT#
(Adds msssing is based oa the Wormation - must be accurate)
""' `' CONTACT PHONE #
PROPERTY ADDRESS: Gp -
P14ONE #: Hozxme ( ) Work (
OWNER MAILINO ADDRESS: S� Z,ko N - CITY:' i 6 STATE : g"3 K2
EMAIL FAX
L T : (If other than owner)
(Applicant if other than o%mer, a statement authorizing applicant t act as agent for owner must ac this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STAVE; ZIP EMAIL FAX
PHONE #: Home (
Work( ) Cell ( )
-CONrRACTiDR
MAILING ADDRESS: 2y S; ff l CITY TATE I Z,Ip g3
PHONE: Home# _
W0 r'k - #VZff ZLL&L Cell# 3 _ — (92 1 1 - 7
EMAIL FAX a!A 2„�_
How many buildings are located on. this property? 2�
Did you recently 9 0Z s plapc*? No Yes (1f yes give owner's name)
Is this a lot. split? (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., 5i*Ne Family Residence.
Family, Apattlaettls, Remodel, Garage,
Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: of be
rend Ibis under
aPpiic®nion end sttilte that the informadon herein is comet and I swear that any information whit it mey hetea�r n r pa t of
in h ewing urt• 1 hert�by certify that I have
and Zoning Coltlmisslpa or tits City coun for the Gty of Rexburg a11eJ1 hut}t#b1 and cmrr.Ct. I a$reo to eomy with all City naaJatio►u an d 3t t r awg o retatM� I t
su bjcat matbcr this Tm ca p and hrn;by autAorizcd represcntalivaa of tho City m toter upon
applfca the above - mentioned props ty for inspections purposes, NOTE: The
building of cial may he pl ans s an perrait an apptvval issued under the provisions of the 20031rttern Code in cages ofAby Me ==ent or Ml
he
Ilea don or on the pls which the pin or approval was based. Pemjt void if= start A wrtltin 1$0 days. Pcrrmit void if VMek eal�oa
fdr 180 days.
Signature of Owner /Applicant Iv / 3 I Q49
Do you prefer to be contacted by fax, email onc? DATE
w4x,lvnv� - sont,nn�rc P irele One
Plan fees ace non - refundable and are paid in 9511 a t th ti of Ol catioQ�be na C11011i 8>R :
City QfJ( abuirg's Acceptance of the plan review fee does not constitute plan a pp r �,� a�
10/17/2006 07:58 2084584076 PAYS RACING LLC
ZuUn I U; S`1AIVI • •
IMWWI�
No. 2994 P. 3
Building Safety Department
CRY of Rexburg
y o
19 E Main icrnatlh@rexburg.org 208,359,3020 x326
Rpxbu� 1D &U40 www.rexOvrg.org Fax 208,359.3024
NAME S UU o
PROPERTY ADDRESS to 1,U S p e
SUBDIVISION Permit#
Required!!!
MECUAN.ICAZ
Mechanical Contractoes Name:
Business Name:
Address ---
City _S±- -
State� lip �3 �L IS
Cell Phone: ()Z7k) 3 — b2(4-1 Business Phone: (208)
Fax: (fig) 2 — 1_j, 7Z Email
Mechanleal Estimate S�` (CommerciaMMulti Family Only)
MTURES c& APPLI COUNT (Single Family Dwelling o nl y )
L Furnace
Exhaust or Vent Ducts
Fumce /A,ir Conditioner Combo [` Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Range Hood Vents
Cook Stove Vents
Bath Fast Vents
— _ other similar vents & ducts:
Pool Heater
2_ Fuel Gas Pipe Outlets including stubbed in or Future outlets
Seat (Circle all that apply) (a Oil Coal Fireplace Electric Hydronie
.... �� Asa �
t �� ust be s gown o Dins.
Signature ��ofjjce�,�IsLd&n�tjactor� t -
License number Date
CITY OF
REX
c1�
Amerlms ��ni1y Cnmrn�nity