HomeMy WebLinkAboutAPPLICATION - 06-00562 - Valley Wide - Shop - Mechanical15/11 '06 WED 09:14 FAX
N %v. 1:, 2 'a;22AM � � . N.., X11(, f'.
CITY' of REXBUR
MECHANICAL PERMIT APPLICATION Please 0600562
19 E MAIN, REXBURG, ID_ 83440 If the qui Valley Wide Coop -Shop
208-359-.3020 X326 Cnty Mech
U
PARCEL NMBER: - 1' N
SUBDIVISION: tLvt, UNIT# BLOCK# LOT#
(Addressing is based on the inform,atio � must be accurate)
OWNER: CONTACT PHONE # gs'6 - x:60 j
PROPERTY ADDIY S :
PI "IONS #: Home 3&> Work (2,9g' . / Cell( ) o 3 jr
OWNER MAILING ADDRESS STATE: � •ITY: _ 64 0
EMAIL FAX 3S 70 -2�3 890
@1 003
APPLICANT (If other than owner)
(Applicant if other than owner, a statement applicant to authorizing applica to act as agent for owner must accompany this application _ -)
APPLWANT INFORMATION: ADDRESS CITY:
ST ATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work (
Cell ( )
CONTRACTOR
MAILING ADDRESS:
PHONE: Home# Work;T Cell#
EMAIL..._..— ._..... _. .
STATE ZIP j4c /0
How many buildings are located on this property? , -
Did you recently purchase this property?0o ' Yes (If yes give owner's nalne)
Is this a lot split ?(! )YES (Please bring copy of new legal description of property)
PROPOSED USE:
6 -e -, Single Family Residence, Multi Family, Apfimrteriw, Rcmodel, Garage, Commercial, Addition, Etc -
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of perlury. ho r cby ccrz that I have
rrad'this application and swo that the information herein' 1S correct and I sweat rhar any Urformation which may hereafter be given by me in bearings hcdbre the Planning
and Zoning Commission or the City Cot,ncil for the City oC Rcxhurz shall be truthful and ctr i"m I agtcc io comply with all City regulations and Stare laws rotating to dic
w+ icct manor of this applickojon and hcrebv duthorittad represenrativcs of the City to emer upon the xhava- mentioned pTOperty for inspections purposes- NOTE; The
building official may (evoke n permit on approval issued under The provisions of ncc 3003 ]ntetrtruionel Code in eaks Of any fake stnaemcnt ormismpmentetion of fact in
the apps' tan c p is on which the pe t or ePproval was based Permit void if not stetted within 190 days, Permit void if Work stops for 190 days`
si
- Z( - 1, /r / D 4�1
DATE
Do you prefer Wbe contacted by fax, email or phone? Circle One
WAANrNG — BUILDOG PERNITT MUST BE POSTED ON CONST RUCTION RUCTION SIT$!
Plan fees are Lion - refundable and are paid in full At the time of applicntion beginning 1anu 7
City of Rerborg'c Acceptance of the plan review fee does not constitute plan approval
15/11 '06 WED 09:13 FAX
N. j, 1 200- 9: 13AN1
Ll
Dryer Vents
Building Safety Department
CHy of Rexburg
19 F Moin jonelih0rarburg,org Phone :3U8,3S9,3020 x326
reexbur9. ILA 33J" www.rcxZ�urg.vrg For 208,359,3024
NAME Va 11
PROPERTY Al
SUBDIVISION
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[a 002
C II D FF
REXB V
Americ -1 Famdy Cx mrnkniry
2 ? uJy Permit#
Required!!!
MECHANICAL
?Mechanical Contractor's Name: Business Name:
Address te� t? /4. Ciry to State 1 Zip e3 0
Ccll Pbonc: ( .) �(oZ 3 _Business Phone:(
Fax: ( ) 3 -- S 12 Email
Mechanical Estimate S _ (Commercial/Multi Family Only)
FD0 URE, & APPLIANCES COUNT (Single Family Dwelling Only)
4,/ FurnaCZ E\1'iaust or Vent Ducts
F urnucc /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit IIeater
r Space Heater
Decorative g8,5 -fired appliance
Incinerator System
Boiler
Pool Neater
• N 116 F'. 4
Ran;e Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
__.__..., Fuel Gas Pipe Outlets including stubbed in or futwe outlets
I leat (Circle all that apple Oil Coal Fireplacc Electtic Hydronic
Mechanical Sizing Calculations must be submitted with Plans & .A, lic a tion
Point of Delivery inust be shown on plans
Sigiature of Licensed Contractor License number
3W ,3 - rm i�� - _- 107zf41
The Ciry of'Re;xburg .y perrn1rfoe
Date
,.; — U60 5q(- ?,.,,,kAo,",`/Cf' SID
schedula is the same as required by the State of Idaho,
is (1 `,�,.., 6_- c