Loading...
HomeMy WebLinkAboutAPPLICATIONS - 06-00595 - 2580 Diamond H Ln - New SFR MechanicalCITY OF REXBURG • PERMIT # MECHANICAL PERMIT APPLICATION Please v 19 E MAIN, REXBURG, ID. 83440 If the questh 0600595 208- 359 -3020 X326 2580_ Diamond H Ln -Cnty Mech PARCEL NUMBER: ��_'�� ( We SUBDIVISION: C (oK - UNITS t3LUUx# LOT# (Addressing is based on the information - must be accurate) OWNER: ©N VLJC b e- r CONTACT PHONE # 390 lot Z PROPERTY ADDRESS: L 5 8 0 'D" t> f4 1"4 Nle PHONE #: Home ( ) OWNER MAILING ADDRESS: EMAIL CITY: FAX Work ( ) Cell ( ) 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; ZIP PHONE #: Home ( ) EMAIL 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) 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. 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 ionellh@rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 OF REXBUkC CITY OF ° REXBURG Americas Family Community NAME PROPERTY ADDRESS SUBDIVISION Permit# Re, quired!!! MECHANICAL Mechanical Contractor's Name: Z> i �6 Yl ✓1 O�) Business Name: S 0� nSo�j Petr t�,vcl 1 L Address & L I& w j J 0rW(& C , Kc.1 e City 2@ 6,) State Xb4 tiv Zip 83 Cell Phone: (& o5`2 Business Phone: ( ) Fax: S& - aS ZS Email �v&>j 6A rj_,/� rLl e 0j . Cow Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only) Furnace -� Exhaust or Vent Ducts 2 Furnace /Air Conditioner Combo C__�u Z Dryer Vents 1 G Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater 3 Decorative gas -fired appliance }C� Incinerator System Boiler Pool Heater Range Hood Vents Cook Stove Vents (a Bath Fan Vents %? other similar vents & ducts: W A,-ar ke "I-, v 4? .j- - Fuel Gas Pipe Outlets including stubbed in or future outlets 1�5 Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic Mechanical Sizing Calculations must be submitted with Plans & Application /1 A Point of Delivery must be shown on plans. _ L3;2 - 7 Signature of icensed Contractor License number The City of Rexburg's permit fee schedule is the same as L/ zcv& Date by the State of Idaho