HomeMy WebLinkAboutAPPLICATION - 06-00563 - 817 Heritage Rd - New SFR MechanicalN
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Plea;
19 E MAIN, REXBURG, ID. 83440 If the c
208 - 359 -3020 X326
Work ( )
PARCEL NUMBER: We will provide this for you)
SUBDIVISION: �— T UNIT# BLOCK# LOT#
(Addressing is based on the information - must be ccurate)
OWNER: AET t fe, CONT CT HONE #
PROPERTY ADDRESS:
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
0600563 n!
817 Heritage Rd -Cnty Mech ale
CITY:
FAX
Cell ( )
STATE: 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
CITY:
STATE; ZIP EMAIL
PHONE #: Home ( )
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP.
PHONE: Home# Work# Cell#
EMAIL FAX
How many bulldmgs are located on this 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 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 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.
Work ( )
W .' ",
Cell ( )
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
0 r
Please complete the entire Application! If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: XI D(E.J ��✓ISti.� Business Name:
Address &-'/& c i`K I c City P. --OOr4 State 1 4c Zip 8
Contact Phone: - c z 5_ Business Phone: ( )
Email w :.; f d ki s A-) Co•-\� Fax 3 6 z5�
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & 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
2 Bath Fan Vents
other similar vents & ducts:
J f - or &g - 4A9,a.rC7_ \(.e J 'r
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI - 1'; I C� A-,- cor
Heat (Circle all that apply) Gas it Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
/? # / Point of Delivery must be shown on plans.
Signature of L' ensed Contractor License number
The City of Rexburg's permit fee schedule is the same as
AI 7, Zc249 to
Date
the State of Idaho