HomeMy WebLinkAboutAPPLICATION - 07-00127 - 449 Partridge Ln - New SFR MechanicalCITY OF REXBURG PE
MECHANICAL PERMIT APPLICATION Please con 0700127
19 E
208-359- 020 32
BURG, ID. 83440 If the question 449 Partridge -Cnty Mech
PARCEL NUMBER: ((�� , u� ( ( We will proviae tnls for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS:
CONTACT PHONE # 2 l - Oo (,off :3:�f
VQ_
PHONE #: Home ( ) Work ( ) Cell (901) I
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OWNER MAILING ADDRESS: qqo P/m tV Ur ' CITY: P'I<.t'` STATE: tU ZIP: g'3H Ll( ..
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
STA
PHONE #: Home (
Work ( )
FAX
Cell ( )
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 this application and hereby authorized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building offi ' ay voke 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 applic on or oh �e plans ,on�vhich the permit or appr w as based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
CITY:
ZIP EMAIL
L / ��
DATE
Do you prefer to be contacted by fax, email or phone? ChvJR One
WARNING — BUILDING PERMIT MUST BE TED 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
0
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
C I T Y OF
REX B
Americo Family Community
OF R$RB URC
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NAME at ...
PROPERTY ADDRESS
SUBDIVISION r^ � a i
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Permit#
Required!!! MECHANICAL
Mechanical Contractor's Name: 44� e;f�/ �e `r• �'�°7e. '� ,, Business N e:
Address 1(114 � City State
Cell Phone: Business Phone
Fax: (1 ) �� �' �' Email_
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwellin Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Z Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
ple —T." lv/_,��
/ Dryer Vents
Range Hood Vents
Cook Stove Vents
�— Bath Fan Vents
other similar vents & ducts:
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Ga ` Oil Coal Fireplace lectr' Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The
License number
's permit fee schedule is the same as
the State of Idaho
7 - 2
Date