HomeMy WebLinkAboutAPPLICATIONS - 06-00628 - 387 Airport Rd, #48 - Gas Line0 •
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please c 0600628
19 E
208- 35 1AW, EXBURG, ID. 83440 If the questi 287 Airport Rd #48- Mechanical
PARCEL NUMBER &F,'X V,, �, 5 (W,
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: q� r V__ G1 �—(k FJ CONTACT PHONE # 0 C �e - 6 - U ! J j
PROPERTY ADDRESS: - 3&7 119 ( r o r f `1
PHONE #: Home ( ) Work Cell (W b d 1 3
OWNER MAILING ADDRESS: 5 0 1 CITY6&DttM STATE - -1 ; 7- 0 ZIP: v
EMAIL FAX
APPLICANT (If other than owner) _ +A-
(Applicant if other than owner, a statement authorizing licant to act SS age�t f er ust a m this a lication.)
APPLICANT INFORMATION: ADDRESS IT
STATE: , A (1 ZIP !-
Z J U U EMAIL FAX
PHONE #: Home (
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 cpy of new legal description of
PROPOSED USE: (a (Z6 / / g e �y / / 1() 0 l l e CW j'I'1 L
(i.e., Single Family Residence, Multi FamilyOAp Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalt 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 I Ler of this application and hereby authorized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
buildi fficial 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 c ' n or oft plans o hi the permit or approval was b e . Permit void if not started 'th' 180 days. Permit void if work stops for 180 days.
/ OG
Signature of Owner /Applicant DATE
Do you prefer to be contacted by 4, email or p one? 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 janellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
C I T Y O P
REXBURG
Americas Family Community
04 4tix6 URC
U � O
l
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MECHANICAL
Mechanical Contractor's Nam e(��' Business Name:
Address City State
Cell Phone: ( ) Business Phone: ( )
Fax: ( ) Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES 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 apply) Gag Oil Coal Fireplace Electric Hydronic
Mechanical Sizinp, Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor License number
Date
Zip