HomeMy WebLinkAboutAPPLICATIONS - 06-00622 - 2157 Diamond H Ln - New SFR MechanicalCITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please cc 0600622
19 E MAIN, REXBURG, ID. 83440 If the questic
208- 359 -3020 X326 2157 Diamond H Ln -Cnty Mech
PARCEL NUMBER S'' LLE 01 C01 D ( We wire Eivvluc alts Cur you)
SUBDIVISION: UNIT# BLOCK# LOT # _A__
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS: / 7 f 1,4 ,4?d /VJ /4
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT (If other than owner) yYl. le -e a
(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 (
CITY:
EMAIL
Work (
Cell ( )
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property?
FAX
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 penalt of perjur I hereb certif 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 issu r-.(he provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or orb plans on which the or app val was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
of Owner /Applicant —
/ :Z / / 0Z
DATE
Do y'ou prefer to be contacted by/fax, email or phone? Circle One
WARNING I- 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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C I T Y OF
REXBURG CW 11 __ _ _.
Americas Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Required!!!
MECHANICAL
Permit#
Mechanical Contractor's Name: ell .2. Id Business Name:
Address l3dx / p` g` City �a (f r State L2 Zip f
Cell Phone: 3 yp _ ` y Business Phone: ( )
Fax: ( )
Email
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
; 2_ 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
1 — Dryer Vents
Range Hood Vents
Cook Stove Vents
X Bath Fan Vents
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on Dlans.
Signature of Licensed Contractor
License number
/ X
Deite
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho