HomeMy WebLinkAboutAPPLICATION - 07-00053 - 3865 W 2000 N - New SFR MechanicalJan. 16. 2007 11:45AM
MY OF REXBURG►
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 -359 -3020 X326
• No, 3504 P. 2
0700053
Pleas 3 865 W 2000 N -Cnty Mech
q uest
PARCEL NUMBER:) 1 l Ji P P
We will provide this for you)
SUBDIVISION: red UNIT # LOT #
(Addressing is based oA the-' formation - must be accurate)
OWNER: CONTACT PHONE # 10
PROPERTY ADDRESS: L OCO A)
PHONE #: Home ( ) Work ( ) '3M 'NO 4 0 Ce11( ) 3� — `� (0 l lzs
OWNER MAILING ADDRESS: CITY: STATE:0ZIP: y'tC)
EMAIL
FAX 35] `— '7 g t- (
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to
APPLICANT INFORMATION: ADDRESS
STATE; ZIP MAl
PHONE #: Home ( ) Work (
for owner must accompany this
CITY:
FAX
Cell ( )
CONTRACTOR
MAILING ADDRESS:
CITY
PHONE: Home# Work# Cell# �s `7 — C,049
EMAIL
AX
How many buildings are located on this property?
STATE
Did you recently purchase this property? No 1 e of yes give owner's name) s C�c Pn S L C
T
Is this a lot split? NO YES (Please bring copy of new legal description of property)
(i.e.,,8"mgle Family Residence;
Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under poalty of perjury, I hereby certify that I have
read this application and state that the information herein is correct and I swear that any infoormation 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 truthfW and correct. I agree to comply with all City rtguMons and State laws relating to the
subject matter of this application and hereby authorized repro ntatives of the City to cnta upon the abovo-meotioned property for inspections purposes. NOTE: The
building official may revoke is p ton approval issued under the provisions of the 2003 Interoatiooal Code in cases of any false statement or misrepresentation of fact in
the application or on the pl which the permit or approval was based. Permit void ifnot slatted within 180 days. Permit void if work stops for 180 days.
?
Signature of er/Ap&ant ATE
Do you p o contacted by fax, email or phone? Circle One NIN
WARNING — HUEl DING PERMIT MUST HE POSTED ON CONSTRUCTION SITE:
Plan fees are non - refundable and are paid in full at the time of application beginning laeuary 1.2005.
City of Rex burg's Acceptance of the plan review fee does not constitute plan approval
Jan, 16. 2007 11:45AM •
9 No. 3504 P. 3
Building Safety Department
C"y of Rexburg
19 E Main lonellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fox: 209.359.3024
CC pECB
CITY OF
REXBURG
'� •^ Americai Family Community
NAME Ctkw
PROPERTY ADDRESS ACS rl1
SUBDIVISION ! ' nr " f L
MECHANICAL
Required!!!
Mechanical Contractor's Name: i A) )�tL,t, Business Names
Address 2�� �¢ ul , ` g - D S� City g gt, r State 7 j:b Zip $V
Cell Phone: Business Phone: ( ) ,.zZ
Fax: ( ) -5�'Le — D�2Z� Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
_ Furnace Khaust or Vent Ducts
Furnace /Air Conditioner Combo
)fit Pump
Air Conditioner
~ aporative Cooler
LhIrt Heater
SPi6e Heater
Pe- corative gas -fired appliance
bx System
B611er
P,! e eater
oldffer 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
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The City ofRexhunq's
Z Dryer Vents
Permit# m d (o 1l C) L I
R6nge Hood Vents
1215ok Stove Vents
_, ;), Bath Fan Vents
4ke, t Z&?)
License number
schedule is the same as
the S tate of Idaho
Date