HomeMy WebLinkAboutAPPLICATION - 06-00559 - 1695 Clements Ln - New SFR Mechanical2085240801
No v. 13. 2�IG5 1: �7PP�1
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
PE
'lease coin
• Nu. 3065
0600559
X002
P. 2
19 MAI R 6 R G ' � S3440 If the action 1695 Clements Ln -Cnty Mech
PARCEL NUMBER: 6 (o Ot 39 �1 N qo� ( We wiu proviae uus Am yW4
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the inforam ion - Trust be accurate)
OWNER; CONTACT PHONE #
PROPERTY ADDRESS: 16 �j e w1 �Y%.�s
PRONE #; Home ( ) Work ( ) Cell (
OWNER MAILING ADDRESS:
EMAIL
CITY: 4 o�A STATE: ZIP:
FAX
A PPd.I 4W . (If other than owner)
(App}icant if other that ow=, a smmtemcmt aUhaYi21ng applicant to be ati Agent for cw=r mast accompany this application.)
APPLICANT INFORMATION: ADDRESS
CITY:
STATE, ZIP EMAIL
-
M
PRONE #: Home ( ) Work. ( ) Cell ( )
CONTRACTOR
MAILING ADDRESS: u17S zz:, . criy R, STATE ". , SIP 9 3y (4 ,;L
PHONE: Home# 1 9a5 Work# Cell# .390-
EMAIL FAX 2 s Bas
How many buildings aze located on this property? -a-
Did you recently purcbase this property? No Yes (If yes give owner's name)
Is this a lot spW (90D YES (Plcasc brhag copy of new legal description of ProPefty)
PROPOSED USE:
(i.e., Single Family Residence,
ApmMepcts
Garage, Comm Addition, Etc.)
APPLICANT'S SIGNATITRE, CERTIFICATION AND AUTHORIZATION: undsrpeeahyafpcdoy,l&m yasr4lyytbatlhaae
read Ws eWiczian End dtdr thxt the infnrmmion herein is coact[ arid I sweat ttta any infot uatim wbicb may hereafter be given by rAc in A rwiw —gs befit the f7annatg
snd Zoning Commission or to city Coundl for the City of &asbtag shall be t uWA aid ea act I agrra to can]* with all City Ngulatims Sind SWC laws m1atigg to thr;
subject mzdcr of ibis applicasion std bcmby WU=i=d rnprasoawdyas of the City to actor upon tbo abvre- tiowd property for hmpw iom Purposes. Nam The
boil ft official mey ravokc a permit an approval imcd tmdcr the prov;siaw of the 200 hrternrttoral Code in cA509 of any false SlEftmcnt or ziaeprose action of met in
thn oppho6m or m the phms on wbkb the permit of appmvA was based_ Permit void ifaot started witbin ISO days- Pmwa void ifwa& stops for 180 days.
/ I
Signature of Owiaer /A,pplicant DATE
Do you prefer to be aantai;ted by fix, hail or phone? Circle On*
WAgrjING — BUILDING PERAuT MUST BE POSTED ON C93NSTRUCTMN 9=1
Plan fees are qon refundable and are paid in {'p at the time of application beginning lrnrcrmv I, NJOS
City of Retburg's Acceptance of the plan review fee does not constitute Plan approval
Jt Wy L 1 uu: L' _4&I A2Lt Gt`
1/14/2006 12:17 FAX 2085240801 B &S BOILER INC
14ov.13. 2036 1 :37 PM •
@J 001
No. "J085 P. 3
Building Safety Department
City of Rexburg
19 F Maln janefih@Iexburg.arg ?hone. 208.359.3020 x326
Rexburg, ID 9344 www.rexburg.org Fox: 208.359.3024
�] C[ T x O F
u R V RG
n
cw
,��neriaa3 Family C=murriiy
NAW
PROPERTY ADDRESS 6 q 5 c_ I
SUBDIVISION
P=Iit# Cx on�jl
Required r ► r
MECHANICAL
Mechanical Contractor's Name: K y �e- ' rA e. sa yA— Business Name: 13 1 +�uv' �►nc.
Address 15 1.J S ALle- - ___ City, 3-Aa .g}y1 Is Stata _ _ Zip 83 Oa;
Cell Phone: (�05 ) -'Sq — 4 I S - 7 Business Phone: WS) S aR L4 — 0 3 7
Fax: (JOS ) Sa — 080 1 Email bs ba 1 _ sy o, A
Mechanical Estimate $ D (Coyninn al/Mull Family Only)
FFXTUddES & AM1A ACES COUNT (single .Fuzz* Dwelling ®silly) c '
J• Furnace _ �G� �_ Exhaust or Vent Ducts -�
Fumace/AJr Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorativc gas - fircd appliance
incinerator System
Boiler
Pool Heater
- Y Fuel Gas Pipe Oudetis including stubbed in or future outlets l C -D T c�
Heat (Circle all that apply) Gsa Oil Coal Fireplace Electric Hydronic
� l 1 � ``
Mr&h g aAcal Suing Calculations must be submitted with Plans &A ldka 'on
Port of Delitvea Faust be shown on plans.
ftna =. of Licensed Contractor License riunuber Date
-I- Dryer Vents
Range Hood Vents
Cook Stove Vents
2. Rath Fan Vents '� C
other similar gents & ducts:
Ak City afRerburg's permit fee schedule is the same as require' by the Steve of Idaho