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HomeMy WebLinkAboutAPPLICATIONS - 06-00597 - 5465 N 5000 W - MechanicalCITY OF REXBURG � TTTA �r . .. • MECHANICAL PERMIT APPLICATION Pleasi 06 00597 ! 19 E MAIN, REXBURG, ID. 83440 If the qu e 208 -359 -3020 X326 5465 N 5000 W -Cnty Mech PARCEL NUMBER: SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) SO t*--1 OWNER: , A6G M&;*z CONTACT PHONE # PROPERTY ADDRESS: 4 Al 400 -S7 PHONE #: Home ( ) OWNER MAILING ADDRESS: EMAIL Work ( ) Cell ( ) CITY: STATE: ZIP: 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 STATE CITY: ZIP EMAIL PHONE #: Home ( ) FAX Work ( ) Cell ( ) CONTRACTOR MAILING ADDRESS: S T 11)411Q CITY ST. 4NTHO MA TATE, �I) ZIP t-3 YY� PHONE: Home# Work # bay( ? Jl# —3Q0 —Dal EMAIL E". How manv buildings are located on this nronertv'1 Did you recently purchase this property ? (V Yes (If yes give owner's name) Is this a lot split? 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 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 ap roval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in the applic or on the 7pls on which permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. 4�" / �/�/ r/ Signature of Owner/Applija#f DATE Do you prefer to be contacted b 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 Build!Wg Safety Department City of Rexburg 19 E Main lanellh @rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 NAME PROPERTY Al SUBDIVISION OF gT.Xli (;q� � o C I T Y O P REXBURG OW Americas Family Community WA Permit# Required!!! M g CHAj� L l - !-�S�,r2# C�Ct�� C..t Mechanical Contractor's Name: ` pG1�t, t✓ & � usiness Name: Address 0ZfS7_ 1& City 5 State - T_DA -t 0 Zip F:3 W _ Cell Phone: (�ZM 3 Qd 03 1?, Business Phone: (,9 00 & 2c/ — ; �3 7 7 ©Z Fax: (90 &cn . 3 zz y Email A z � S gv n a& C&,1 . 01 Mechanical Estimate $ 6 ,0MCommercial/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 Fuel Gas Pipe Outlets including stubbed in or future outlets Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Heat (Circle all that apply) (Oil Coal Fireplace Electric Hydronic Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Signature of Licens Contracto License number Da The City of Rexburg's permit fee schedule is the same as required by the State of Idaho