HomeMy WebLinkAboutAPPLICATION - 07-00064 - 3780 S 5500 W - MechanicalCITY OF REXBURG PERMIT # ^. '!
F E 8 21 20.07
MECHANICAL PERMIT APPLICATION Please complete the t a Applic
19 E MAIN, REXBURG, ID. 83440 If the questia
208 - 359 -3020 X326
PARCEL NUMBER: t " �(S',k (We 07 00064
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SUBDIVISION: UNITi 3780 S 5500 W -Cnty Mech
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS: ?o 0 S
PHONE #: Home (
OWNER MAILING ADDRESS:
EMAIL
Cell ( )
CITY: 1 % , v w- STATE:PZIP:
APPLICANT (If other than owner) J4B /-gyp A h -A 4
(Applicant if other than owner, a statement authorizing applicant t act as agent Jbr owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 3 3w o W CITY: le-ex 6v V(
STATE; I ' ZIP 34 C? EMAIL
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PHONE #: Home 6 � d� Work �� jyJ(� Cell &'4 ?,L30061(..
CONTRACTOR
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 Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, 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 twis application and reby au rihd representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building offici y rev e a permi n app al i under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the applicati o on plans on ich th ermit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Z / Z/ / —a-7
Signature of Owner /Applicant DATE
CONTACT PHONE #
Work (
FAX
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 Januarp 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 www.rexburg.org Fax: 208.359.3024
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PROPERTY ADDRESS
SUBDIVISION
04 ptixaoA�
y �o
U G
CITY O F
REXBURG
Americas Family Community
Permit# O V 6 b q
Required!!!
MECHANICAL
Mechanical Contractor's Name: Business Name: 41 4 - ke, Q.
Address aN -gc)() q L✓ City & v, State Zip
Cell Phone: Oq) 3 ( 3 as V 1, Business Phone:
Fax: e Email 6 he -,-A 40 rl, .Lei. -
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
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
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
_/ — Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas it Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Y i2tt of Delivery must be st
6
Signature of Licensed Contractor Icense number
The City of Rexburg's permit fee schedule is the same as
the State of Idaho
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Date