HomeMy WebLinkAboutAPPLICATION - 07-00090 - 3827 S 3300 W - New SFR MechanicalCITY OF,REXBURG •
1700090
MECHANICAL PERMIT APPLICATION Please " 3835 S 33 00 W -Cnty Mech
19 E MAIN, REXBURG, ID. 83440 If the questio
208 - 359 -3020 X326
PARCEL NUMBE S2 LLU!G: (J ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: , CONTACT PHONE #
PROPERTY ADDRESS: -3 S 3
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
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 CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR A l e
MAILING ADDRESS: rr CITY S, STATE_J.ZIP f
PHONE: Home# Work# Cell# 3 yU �,T
EMAIL FAX
How many buildings are located on this property? I
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 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 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.
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 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 ianellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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CITY O F
REX BURG
America's Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Dryer Vents
Required!!!
MECHANICAL
Mechanical Contractor's Name: Ate-e kzJ Business Name: blot, I.� /,rig , E 2 _ d
Address P6 &2 /� City State d . Zip iti
Cell Phone: (24) Business Phone: ( )
Fax: (
Mechanical Estimate $
Email
(Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwel in , g 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
other similar vents & ducts:
7— Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply )Ga Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
of Licensed Contractor License number Dat
Permit#
Range Hood Vents
Cook Stove Vents
—3 Bath Fan Vents
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho