HomeMy WebLinkAboutAPPLICATION - 07-00030 - 3126 S 2810 W - FireplaceCITY OF REXB R • •
u G 0700030
MECHANICAL PERMIT APPLICATION Please 3126 S 2810 W -Cnty Mech
19 E MAIN, REXBURG, ID. 83440 If the quel
208 - 359 -3020 X326
PARCEL NUMBE4 `JLVSb=)()A0 (We will provide this for you)
SUBDIVISION: k1 'l(r,; c r✓ UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: A66aAd ( Z 41444elWtatA CONTACT PHONE # 5 - 7 ��
PROPERTY ADDRESS: '3 QLQ S f > !Q 6 /2-e� c t ( :�
PHONE #: Home (�o�j �l ( - C �o ( Work (, �o I ^ � U� �U Cell ( 4 ) c 1'
OWNER MAILING ADDRESS: Sra,�,— CITY: STATE: ZIP:
EMAIL 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; ZIP
PHONE #: Home (
Work ( ) Cell ( )
CONTRACTOR �Y4,ytA P r
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 (fe�(If yes give owner's name) zt ,n v, -, e r/„
Is this a lot split? J YES (Please bring copy of new legal description of property)
PROPOSED USE: S 1 (e
(i.e., Single Family Residence, Multi Family, Al
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S 7 hat NATURE, CERTIFICATION AND AUTHORIZATION Under penalty of perjury, I hereby certify that I have
read this applicatio d 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 Co. rssio City C City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the
subject matter pplicat d hereby authoriz representatives of ity to enter upon the above - mentioned property for inspections purposes. NOTE: The
building ofd gal m revo ermit on approval i ed under visions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the appli ion
o on th ans on which the p it orb Vg was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
7—
DATE
CITY:
EMAIL
FAX
to o tacted by fax, 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
Building Safety Department
o �AEXB� R � ,
City of Rexburg �� s
19 E Main janellh@rexburg.org Phone: 208.359.3020 x326 Y'•<,
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
C I T Y O F
REXBURG
Americo Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Requiredl!!
MECHANICAL
Mechanical Contractor's Name: 01_414.el Business Name:
Address City State
Cell Phone: ( ) Business Phone: ( )
Fax: ( ) Email
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
` Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho