HomeMy WebLinkAboutAPPLICATION - 06-00553 - 355 Partridge Ln - New SFR MechanicalCIFf OF REXBURG •
applicant to act as agent for owat-4 must accompany this application.)
MECHANICAL PERMIT APPLICATION Please c 06 00553
19 E MAIN, REXBURG, ID. 83440 If the quest 355 Partridge L n- C my M ech
208 - 359 -3020 X326
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is base �
on the informa - must 1 -e accurate)
CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home ( ) ' Work ( )
OWNER MAILING ADDRESS: CITY:
EMAIL
FAX
EMAIL
APPLICANT (If other than owner)
(Applicant if other than owner, a statement
APPLICANT INFORMATION: ADDRESS
STATE; ZIP
PHONE #: Home ( )
•
_ Cell ( )
STATE: ZIP:
CITY:
FAX
Work ( )
Cell (
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name) t6 11
Is this a lot split? NO YES (Please bring copy of new legal description of y ) A , ^nn
in
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Ad ition,
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION iTY U F R EX U R 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 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 s on which pi a roval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
I f/ / l O 6
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
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
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CITY O F
REXBURG
Americas Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
2 Dryer Vents 1 0
Required!!! ECHANICAL
Mechanical Contractor's Name: ri r' �
Business Name:
D-L-aa
Address C14 UCdv, — City ^]E:�N a _ State Zip 5(Z j
Cell Phone: 9 8) 58T 413 Q Business Phone: iro 2o 6_ZZ_
Fax: V0,5) 2 :;�Z Z — Z e t - 3 Email
Mechanical Estimate $ a Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) ;1b Z \r2 — Furnace � Exhaust or Vent Ducts C4 �
&Vt� k-'�
Furnace /Air Conditioner Combo ' ;-j
Heat Pump
— Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance 1 G '
Incinerator System
Boiler
Pool Heater
Range Hood Vents
Permit#
Cook Stove Vents
6 Bath Fan Vents 7d
other similar vents & ducts:
/,' — Fuel Gas Pipe Outlets including stubbed in or future outlets AO
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
AV"
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
f2o l a
License number Date
The City of R exburg's permit fee schedule is the same as required by the State of Idaho