HomeMy WebLinkAboutAPPLICATION - 07-00045 - 3151 N Salem Hwy - New SFR MechanicalCITY OF REXBURG 0
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
PARCEL NUMBER:
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SUBDIVISION: UNITh
(Addressing is based on the information - must be accurate)
0700045
3151 N Salem Hwy -Cnty Mech
PROPERTY ADDRESS:
PHONE #: Home (4o )J.,359
OWNER MAILING ADDRESS:
EMAIL
f
7
CITY: - u D STATE
FAX
APPLICANT (If other than owner) 1 )0 0 Kwwm V-t I I
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION:
STATE; ' Ed ZIP
PHONE #: Home (
PERMIT #
Please comulete the entire Application!
If the questioi
CONTACT PHONE #_
sa
( ) Cell
Work (
FAX
Cell ( ).
CONTRACTOR
b
MAILING ADDRESS: (Q `� y lV 7 -1-11- E CITY LA r STATE ZIP f� L l tl
PHONE: Home# Work# Cell# :39 Q-
EMAIL
ADDRESS C Q C 1 IV Il0 7 ��' CITY: c s Y^
EMAIL
FAX 5'I " < L {Z
How many buildings are located on this property? 2 !
Did you recently purchase this property?4oYes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: S i mi \-4�' F41w\t
(i.e., Single Family Residence, Multi amily, Apartments, Rei
Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalt of perjur 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 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 ma 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 application or n ilk
plans on whic)rt�e permit or approvAwas based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
L.��!-"` I �_/ / 07
Signature of Owner /Applicant DATE
Do you prefer to be contacted 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
'qw•
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
OF QEXBUAC
CITY O F
REXBURG
Americas Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MECHANICAL
Mechanical Contractor's Name: (JnVA �orf e Business Name:
Address City State Zip
Cell Phone: (
Fax: ( )
' 70 7 Business Phone: ( ) s b— 7 d 1 Z
Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIS & APPLIANCES COUNT (Single Family Dwel ang Only)
Furnace �. Exhaust or Vent Ducts
Furnace /Air Conditioner Combo Dryer Vents
Heat Pump
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
other similar vents & ducts:
Pool Heater
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
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
License number Date