HomeMy WebLinkAboutAPPLICATION - 07-00142 - 2360 W 3800 S - New SFR Mechanical0
IVITY - OF REXBURG 07
MECHANICAL PERMIT APPLICATION Plea
N E MAIN REXBURG, ID. 83440 If the 23 60 W 3 800 S -Cnty Mech n e
208 - 359 -3020 X326
PARCEL NUMBER: �J �� ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
CONTACT PHONE # JW 3
PROPERTY ADDRESS:
PHONE #: Home (2db) j Work � o lC - 3�7� Cell ) ��`/ 9 �r_
OWNER MAILING ADDRESS 3foo �^ CITY: STATE:VZIP
EMAI I4&n��ffA ./lx' 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 (
ZIP EMAIL
Work (
•
CITY:
FAX
Cell ( )
CITY STATE ZIP
CONTRACTOR
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work#
FAX
Cell#
How many buildings are located on this property? M?_
Did you recently purchase this property? No &If yes give owner's name)
Is this a lot split? YES (Please ]-ring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, X461ti Family,
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 approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the tion or on the plans o n the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
... * 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 January 1, 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
or
Building Safety Department
City of Rexburg
19 E Main jonellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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America's Family Community
NAME QmAn _4sdro._Ix
PROPERTY ADDRES .2��v l✓ 1 wDVS Permit#
SUBDIVISION -
Required!!! MECHANICAL
Mechanical Contractor's Name: / 14 Its p usiness Name:
Address �' n9 City ��cr �''i "��/ State Zip
Cell Phone: off) . �jb Business Phone: (�j,?
Fax: Email
Mechanical Estimate $ 7` (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
I V OI F urnace I— Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
D ecorative 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 Outle cluding 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
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The City of Rexburg's permit
License number
schedule is the same as
Date
by the State of Idaho