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HomeMy WebLinkAboutAPPLICATIONS - 07-00273 - 3887 W 2000 N - New SFR MechanicalCITY OF REXBURG • MECHANICAL PERMIT APPLICATION Please co 0700273 19 E M AIN, 208 -359- 020 X3 B URG, ID. 83440 If the questiol 3887 W 2000 N- Gulley PARCEL NUMBER: (We N SUBDIVISION: r UNIT# BLOCK #LOT# (Addressing is based on the information - must be accurate) OWNER: CONTACT PHONE # PROPERTY ADDRESS: © U c.I Oy /✓ PHONE #: Home ( ) —!S S `S Work ©G iU Cell ( OWNER MAILING ADDRESS: �$�/� �� LJ CITY: 4Aj(f STATE: ZIP: U EMAIL ff" APPLICANT (If other than owner) (Applicant if other than owns ,, a statement authorizing applicant t APPLICANT INFORMAM ADDRESS STATE: EMAIL PHONE #: Home ( ) I01 ". as agent for owner must accompalty this application.) CITY: Work ( ) 1�1_ Cell ( ) CONTRACTOR ., LI NI i9014i.'"I b1 10 PHONE: Home# EMAIL CITY STATE ZIP Work# Cell# '( G o 'I I I�� How many buildings are located on this property? ']L— Did you recently purchase this property ?& Yes (If yes give owner's name Is this a lot split? ] 0) YES (Please bring copy of new legal description of property) (i.e., mgle Family Residence, Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICAIQI CERTIFICATION AND AUTHORIZATION: Under penalt 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 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 gWAich the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. J111!_1 - ( l aV l <5- Signature of O er /Applicant DATE Do you prorer 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 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 Of pEXBU,gC UN� O CITY O F REXBURG America's Family Community NAME � G,,[ l ,y PROPERTY ADDRESS 3 `K) W d - SUBDIVISION Required!!! MECHANICAL Mechanical Contractor's Name: µt tit Gt�jEs� M usiness Name: Address 2 P311 UU . 5=0 liZO . City 13 uric State .fib Zip $'S44D Cell Phone: ( ) Fax: ( Mechanical Estimate $ (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 Space Heater Decorative gas -fired appliance Business Phone: ( ) �5 5 - D ?;'?b ) S <& - 0 7t6 3 Email Incinerator System Boiler Pool Heater 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. Signature of Licensed Contracto� The City of Rexburg's Ak, t- / Zoo License number sch edule is the same as the State of Idaho Permit# Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents ( - 20 -6 Date