HomeMy WebLinkAboutAPPLICATION - 07-00148 - 75 S 5th W #2 - Mechanical......... .
APR -03 -2007 TUE 02:04 PM FIRST CALL JEWEL FAX NO. 12085292793
Jul. 1 2005 2:ilr • • "'
Cl17YOFRMURG 48
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1r,D24G PRI T APPLICATION Pie 07 001
19 E MAIN, RBXBURG, ID. 83"0 if th 75 S 5th W #2-Kay
208 -359 -3020 X322 ' i
PARCEL NUMBER: -,L O`tn Kq . --A r T4"• qua �,•, �� �
SUBDIVISION:_ UNIT# BLOCK# LO'I-
(Addressin6 is based on the information - must be accurate)
coNTACT PHONE #
PROPERTY ADEMSS:
P. 02
e
PHONE #: Home ( ) ��� 6 �3 /a Work ( ) CC ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EIv1AIL FAX
(1f otl='khan owacr) i S T Let // l P C.
( ppllcatat if other tUa owner, a statement aurhorizing applicant to act as ageizt for owner must accompany
APPLICANT INFORMATION: ADDRESS 3 49& 4116 Mi l e-
T,., ZIP o EMAIL FAX
STATE;
PHONE #: Home (
Work( ) Cell ( )
MAILING ADDRESS : CITY �STA
PHONE: Home# Work# �, - ' Call#
EMAIL .FAx 5-a 9_ - q
How mittly buildings are located on this propeny?
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., Singl® Fatally iteaidence, Multi Family, Aparanents, Remodel, Garage, Commercial, Additiam, Etc.)
APPLICANT'S SIGNATURE CERTIFICATION AN7D AUTHORIZATION: uflder peaalty ofpet wY I hereby =e*that t
have =d dus anlicadon And setae that the iufvrr A4CQ hotain is owma and I sww
be truthflrf�d 4i= hica�b� we �v
City eo m ain ri and adbra t h s I 29M Planning and Zoning Comminiop ortho City CaancU fir tbv City ofRecbuzg
rela*g to thv saMeot matter of this *Plioot on and hateby sutttorind repteeeam ilm of to Clay to 0= upon trio abovaqtaWancd propM fat WPccd= Pulp=,
NOTE: The haudittg oMGiai my revoke a permit on 4mmvel isa0cd under the proviriom of thr=0 IotctnatoW Codc in cow of any false skd=cW err
tnicrepromm Ian of fact In to application or on rite p1m oa whlob 4W permit of tpptoval was based. pmutt void if rat Swmd within 180 days. Permit Void if work
amps for 180 days_
DATE
Do you prefer to be Contacted by fax, email or phone? Circle One
wAw4WG _ BUrMING PERMIT M BE POSTED ON CONSTRUCTION SMI
Plan on m non -rest» dr o and are paid At lull at tO time of appillmdoA bv&p(Aa January 1..IES
C. ky of Rat "'s Acwptnu oe ad tbn plan review fee dons not eo plan sppraral
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- APR -03 -2007 TUE 02 PM FIRST CALL JEWEL FAX NO. 12085292793 P. 03
-- ju I. 1�;...2..0..05 2; 22rm
Please complete the Ar Application! u the q uestion doe94k $pA fin in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
RequiredUl
Mechanical Contractor's Name:
Address
Dryer Vents
Range Hood Vents
Contact Phone: Business Phone: ( )
Email
Mechanical Estimate S� (CemmerdaUMulti Family Only)
M=,RES do APPLIANCES COLWT (Sing& Family Dwelling Only)
v- Furnace Exhaust or Vent Ducts
Furmce/Ais Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator Systam
Boiler
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or futurc outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
other similar venTA & ducts:
Mechanical Sizing Calculation must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Lfcenead Contractor Lic=e number o
Required!
Th e City of Rexbarg's pe»nir f ®e schedule is the same as reuirBd by the State of'Idaho
MECHANICAL
Business Nam
Cools -Stove Vents
Bath Fan Vents
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