HomeMy WebLinkAboutAPPLICATION - 07-00233 - 1539 W 5000 N - MechanicalCITY OF REXBURG
PE: • 07 00233
9 MECHANI AI PERMI
0 TION Please que 1539 W 5 000 N-A/C Unit
208 - 359 -3020 X326
PARCEL NUMBE F�;�y�( ►� -[)� ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: Iv f CONTACT PHONE #
PROPERTY ADDRESS: 1_5 tV 5- eoo/✓
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: 15 ,, .7; CITY: STATE ZIP: G YM
EMAIL FAX
APPLICANT (If other than owner) �A,0
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS IM-5 - A 5 /V5 CITY: 9/ 5
STATE; ;/' ZIP &V& EMAIL
PHONE #: Home U�8'/ Work (
FAX
) Sa-1� Cell( ) -Sa...,ye,
CONTRACTOR
MAILING ADDRESS: / d frSd l�' / ySr✓ CITY i ° STATE Z ZIP �3W-2—
PHONE: Home# 2 4!�$" 3/,3 AW Nork# s•c nom- Cell#
EMAIL
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
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial,
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: U� � v � ' '� i a
� at I hay
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.
SignatLIre 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 January 1. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
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r�iAY 2 4 ��r
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
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NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: �� /j� 1 ��tel— 5�/4 ` iness Name:
Address
_City State
Business Phone: ( )
Cell Phone: ( )
Fax: ( )
Email
Zip
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL9NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Bath Fan Vents
other similar vents & ducts:
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.
✓y� x 11 77 2 y/4 7
Signature of Licensed Contractor License number Date