HomeMy WebLinkAboutAPPLICATION - 07-00072 - 1892 W 2870 S - New SFR MechanicalFeb, 26. 2007 3:17PM
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CITY OF REXBURG
MECHANICAL PERMIT APPLICATION PIM
No. 3743 P. 3
0700072
19 E MAIN, REXBURG, ID. 83440 If the c 1 892 W 2870 S -Cnty Mech
205- 359 -3020 X326
PARCEL NUMBER: 1 efi\
,j ' 2fj (6 V (We will provide this for you)
SUBDIVISION: ' — UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: l L.J. ;?,g ?V S.
PHONE #: Home .3S'6` 00,3t Work ( ) A Cell ( ) V ® - 00/7
OWNER MAILING ADDRESS: 12&W. QLj-'AD .S CITY: STATE:bZIP: 1? 4
EMAIL l3�tv:ar.,��iws ctt..�F ��o - ,d.�3�
APPLICAN? (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 lj5�- eoAW ArW5tgk A CITY: &X &ea,
STATE; ZIP D EMAIL rlMajyr` ir�wet.tow — 2)
PHONE #: Home ( ) lq Work Cell FA
C XTRACTOR:
MAILING ADDRESS: Belay Ao—. -Snt "�' CITY R,CYRpI..Qi STATE ID ZIP 83ff d
PHONE: Home# 14 Wor0 -OVE0 Cell# 'AD- 3.293
EMAIL rk4j" 1 0("�� S SI - ola?
How many buildings are located on this property? . - - -__3
Did you recently purchase this property? No Yes (If yes give owner's name) Al b
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: -5/Ill G,Lr=7 EA-W /t
(i.e., Side Family Residence, Multi Family, Apartments,
Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Undcr penalty of perjury, I hereby certiivv that 1 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 sha11 be truthful and correct. I agreo to comply with all City regulations and State Isms relating to the
subject matter of this application and hereby authorized mpre; entatives of rho 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 eases of any false statement or misrepresentation of fact in
the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
1 / 66 / .107
DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUC SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning Jmu= J. 2005
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
Feb, 26. 2007 3:17PM
Building Safety Department
City of Rexburg
19 E Maln lonellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org fax: 208.359.3024
No. 3743 P. 4
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NAME QVlQ WWO
PROPERTY ADDRESS tM# A) 41976S
SUBDIVISION
Pennit#
Required! MECMr4NICAL
Mechanical Contractor's Name: A1wPwt Business Name: RWARA a
Address City /�.r gy�6, State /4*" Zip—
Cell Phone: ( ) Business Phone: (2.d 3570 _ S;t ;Lb
Fax: (?pq ) - 5& — VW lv Email
Mechanical Estimate S (Commercial/Multi Family Only)
F'A'T,URESC AFFLIAIVGES COUNT (Single Family Dwelling Only)
_,X_ 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
Dryer Vents
Range Hood Vents
Cook Stove Vents
I Bath Fan Vents
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
Point of Delivery must be shown on plans.
4 I Z�- "R
S*ature of Licensed Contractor License number Date
The
sch edule is the same as required by the State ofl'daho