HomeMy WebLinkAboutAPPLICATION - 06-00606 - Western Fence - FireplaceCITY OF REXBURG •
FAX
MECHANICAL PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the que 0600606
208 - 359 -3020 X326 Western Fence -Cnty Mechanical
PARCEL NUMBER:
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE # _��j! -
PROPERTY ADDRESS: 1� W
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
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
STA
ZIP EMAIL
PHONE #: Home (
DI=i1k XTT J1
9
CITY:
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Work ( ) Cell
CONTRACTOR: 91
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MAILING ADDR
PHONE: Home# & S ;� Work#
EMAIL
STATE /� ZIP
Cell# 0_1_2
How many buildings are located on this property?
Did you recently purchase this property ?�,,, 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 revok 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 a ans on which or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
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Signature of wne Applicant DATE
Do you prefer to be contacted by x, 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 jk CITY OP
City of Rexburg 1 � T —� �G V 1�
19 E Main ioneiih@rexburg.org Phone: 208.359.3020 x326 Americas Family community
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
R equired!!! M CHANICAL el Mechanical Contractor's Name : "'.1w business Name:
Address City State Zip
Cell Phone: ( ) Business Phone: ( )
Fax: ( ) Email
Mechanical Estimate (Commercia ulti Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that app ) Gas it Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
/ 1e*1 4 G /P /
Signature of Li sed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho