HomeMy WebLinkAboutAPPLICATION - 07-00027 - Big Juds - Gas linen
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the qut
208 - 359 -3020 X326
Bid J uds -Cnty Mechanical
PARCEL NUMBE N4'�6
SUBDIVISION: UNIT #_
(Addressing is based on the information - must be accurate)
BLOCK# LOT#
OWNER: J If- //5 CONTACT PHONE ham' '5%o -5i
PROPERTY AD RESS: �� S
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL
I/
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; ZIP
PHONE #: Home ( )
EMAIL
Work (
CITY:
FAX
Cell (
CONTRACTOR /
MAILING ADDRESS: ��y b � /� CITY STATE�ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this pro ertv.
1,J r1
Did you recently purchase this property No Ls (If yes give owner's name) --- - —�
Is this a lots lit cl�q Please brim co of new le al descri tion of roe a p f ( g copy g p p p ) JA N
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, PC.) --
CITY OF RrUf
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Unde rJury, ere y ceiti�y thit f 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 pe it on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or on the p s which the permit p al was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of O r /Ap cant ATE
L J
0700027
Do you prefer to be contacted by fax, ail 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
Building Safety Department
City of Rexburg
19 E Main janellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 �ww.rexburg.org l , Fax: 208.359.3024
NAME
PROPERTY
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address � V y ,:M/
Cell Phone:
Fax: ( )
�
State Zip
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES 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
_,-- Heater
_ Fuel Gas Pipe Outle n ding stubbed in or future outlets
Heat (Circle all that appl Gas it Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & A
CMA NT(A l
oint o f venvery must be shown on vians.
of Licensed Cob ctor License number Date
04 REXBUAC
�a �O
9�
U �
C I T Y O F
REXBURG
_............_.....__._. OW ._.__._._,____
America's Family Community
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
_ / �7y Business Phone:
Email