Loading...
HomeMy WebLinkAboutAPPLICATION - 07-00063 - 1216 Red Cedar Rd - New SFR Mechanical• CITY OF REXBURG 07 00063 MECHANICAL I PERMIT APPLICA' p do 19 E MAIN, REXBURG, ID. 83440 1216 fed Cedar Rd -Cnty McC11 non app ��,�/ 208 - 359 -3020 X326 f PARCEL NUMBER: ( We will provide this for you) 1 SUBDIVISION: S,-, 1Jff5 UNIT# BLOCK# 1 LOT# (Addressing is based on the information - must be accurate) OWNER: CONTACT PHONE # PROPERTY ADDRESS: t2/4 &J Rte( "�), 37�� PHONE #: Home (2cs) 3S/— 533`3 Work (l Cell l5 cs) 3S /- 5333 OWNER MAILING ADDRESS: VSO/ ,Pte( s-�— CITY: � l w� STATE:�ZIP: b EMAI e,O � wwlcK FAX z ©g, 35-r. o2o 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 044 CITY: STATE; ZIP EMAIL FAX PHONE #: Home ( ) Work ( ) Cell ( ) CONTRACTOR MAILING ADDRESS: 1 /„ /�, N or` lcdk CITY r�j STATE�ZIP g �d PHONE: Home# Work# Cell# EMAIL FAX How many buildings are located on this property? I Did you recently purchase this property? No 'e (If yes give owner's name) e(t, Is this a lot split? NO YES (Please bring copy of new legal description of property) PROPOSED USE: 5rr (i.e., Single Family Residence, Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of perjury 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 may 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 on the plosX w* (the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. Signature of Do you pr! Zi DATE 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 Building Safety Department City of Rexburg 19 E Main Rexburg, ID 83440 NAME ` - PROPERTY ADDRESS 12 SUBDIVISION— & ,;,e All ,r 1 Dryer Vents b 6 bbuS Required!!! MECHANICAL Mechanical Contractor's Name: �6e1"y Business Name: �(v Address g k1 T City Z State / Zip 6 3 qq O Cell Phone: (Zo-� ) 1 X 113 3 Business Phone: Qo s) Fax: (Zoe ) g G ©�6 Email ivtor� jj,,,Z V15� , ✓�PJ Mechanical Estimate $ 5 (Commercial/Multi Family Only) FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only) I_ 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 Heater other 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. Xlx zu /,/ Ignature of Icense Contractor jonellh @rexburg.org Phone: 208.359.3020 x326 www.rexburg.org Fax: 208.359.3024 of AExsup� � o C I T Y O F REXBURG Americas Family Community The City of Rexburg's Permit# Range Hood Vents Cook Stove Vents f 3 Bath Fan Vents :So7a License number fee schedule is the same as 2 - 2 0- a:7- Date the State of Idaho