HomeMy WebLinkAboutAPPLICATION - 07-00007 - 1227 Morningside Dr - LarsenJan 04 07 04:11 p Myron Creager 208- 366 -3988 p.2
Jan. 4. 2007 4:40PM • No. JgJO r. i
A
CITY OF REXBURG I 0700007
MECHANICAL PERMIT APPLICATION Please co 1227 Mornin side Dr- Larsen
19 E MAIN, RENBURG, ID. 83440 If the questio
208- 359- 3020 X326
PARCEL NUMBER: _ "V D (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be arcuate)
CONTACT PHONE # 35 Cs - !Z3 -l—'
PROPER'T'Y ADDRESS:— 22 1"401W 'A I L, '�_► () E
PHONE #: Home (?a) ',3 (^ - Gqq' Work ( ) Cell ( )
OWNER MAILING ADDRESS: Sys CITY: STATE LO ZIP: �yy�
EMAIL FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorWng applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR ' s —, i
MAILING ADDRESS: I � ?C L i,.t�n, � 5� 1 CITY �91�,1 �c STATE _ ZIP v I
PHONE: Home# Work# -7 Cell#_
How many buildings are located on this property`?
Did you receatiy purchase this property? No Yes (If yes give owner's name)
Is this a lot split:? N� YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Fantily Residence, Multi FaMily, Apartments, Remodel, Gauge, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Uodcrp=.hyofpcdwy that l have
read d& awfic aion and state that the information herein is career w d 1 swear than any im>hrnmon which Wray hefcaft be Vvm by me in hv atin,gt before pie Planning
and Zoning Camouinim ar the City Cosu+dl for tho City ofttMbutg shad be truthful and cored. I OSM to coWly VMh all City Fesolelions and State laws 1966n8 m the
subica muter of this application cod hereby aut]wri2ed relwesea abves of 64 City io cotar upon the aimn property for irtsperbmts putPOIK NOW: 7bc
bn,ildjjo may tt volx a recant on aP vat issued under the provisions of the 2003 latemetional Code in onus of any false statement or eduePmeotmdon of That in
the 1' err on the pfmn an which n ar approval was based Permit void if not started within till days- Ptnmi void if work steps for 180 days.
- DATE
Do y prefer to be co y fax, email or phone? Circle One
WARr — bunmING PERMIT MUST BE POSTEn ON CONSTRUCTION SITE:
Plan fees arc son- refundable i nd are paid is Full at tke time of application begloniat Jamr4ry 1. aDOS-
City of Rvcbon's Acceptance of the plan review tee does not eoustitvre plan approval
1 04 07 04:11 p Myron Creager 208- 356 -3988 p.1
Jan. 4. 2007 4:40PM N0 ' r ' z
Building Safety Department i epbxSUq�,' CITY O F
City of Rexburg REXBT m G
, V i�
19EMain janelh®rexbog.org phone: 2M.359.3020Y326 ••,,,, ,• Arne.imrFamRjCamnumlry
Rexburg, 0 83440 www.rexburg.org Frw 208.359.3024
PROPERTY ADDRESS 1 " ' ,�/ �[, 5� � �� �1..�.r Permit#
SUBDIVISION ��x���
Required!!! MECHANICAL
Mechanical Contractor's Name: Business Name: ' r
Addre ss / �2 5� 1- (— �,� o u t� a �, City's z.. , �!_ State 1 Zip `�d l
€ Cell Phone: ( ) Business Phone:
Fax: (Z .o n) SL2 I J ��� Email
S
Meehanics i Estimate $ 1 '7 3 (CommerciaUMulti Family Only)
FIXTURES & APPIJANCES COUNT (Single Family Dwelling Onfy)
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 Heaver
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) Oil Coal Fireplace Electric Hydronic
License number
The
schedule is the sage as
the Stare of Id9w
V_
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