HomeMy WebLinkAboutAPPLICATION - 07-00004 - Madison County - MechanicalBulldin'5 Safety Department 1�0 ��XBUA�ro
City of Rexburg
19 E Main
Rexburg, ID 83440
C I T Y OF
REXBU ,_RG
_ _.
janellh@rexburg.org Phone: 208.359.3(
www.rexburg.org Fax: 208.::
V --, < A 07 00004
;o s Groomer Building -Cnty Mech
NAME
PROPERTY ADDRESS
SUBDIVISION
Required!!! MECHANICAL
Mechanical Contractor's Name: V J� Business Name:
Address City State Zip
Cell Phone: ( )
Fax: ( )
Business Phone: ( )
Email
Mechanical Estimate $ -- +( )CD (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES 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
Dryer Vents
Range Hood Vents
Cook Stove Vents
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
17 Point of Delivery must be shown on plans.
Signature of Licensed Contractor
1l( �
License number
The City of Rexburg's permit fee schedule is the same as
Date
by the State of Idaho