HomeMy WebLinkAboutAPPLICATION - 07-00303 - 4030 Molly Dr - New SFR Mechanical0
CITY OF REXBURG
APPLICATION
19 E MAIN, REXBURG, ID.. 83440
208 - 359 -3020 X326
40
0700303
Pl qu eatio co
the
If the qu 4030 Molly Dr -Cnty Mech
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: E5 UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: S��'r, -c /' _ CONTACT PHONE #
PROPERTY ADDRESS: 90 3�
PHONE #: Home ( ) Work ( ) Cell( )
OWNER MAILING ADDRESS:_. CITY: STATE: ZIP:
EMAIL FAX
APPLICANT (If other than owner) % -. T YY
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS d $ G ��' L/✓. CTTY: A Z
STATE; �' n ZIP EMAIL
PHONE #: Home ( ) �% 4,y ZS Work (
CON7RACTOR
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work# Cell#
Q=om!
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? 2M YES
PROPOSED USE: �-^ ,g
(i.e., Single Family Residence, Multi
(Please bring copy of new legal description of property)
, Apartments, 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 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.
DATE
FAX
Cell( ) 3-2--I— C Z&
CITY
STATE ZIP
ignature of Owner /Applicant
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
Building Safety Department
City of Rexburg
19 E Main janellh@rexburg.org Phone: 208."
Rexburg, ID 83440 www.rexburg.org Fax.
NAME
PROPERTY ADDRESS
SUBDIVISION
Email
Required!!!
MECHANICAL
Mechanical Contractor's Name ✓_ kzj� Business Name: I e o "Z � Q &, W>
Address City State Zip G
Cell Phone: („2 ) ; Y (L�� q Business Phone: ( )
Fax: ( )
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo _� Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
other similar vents & ducts:
_� Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply? Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Apalication
� I
Signature of
The
C?S,5 7 a , �
Contractor License number Date
's permit fee schedule is the same as required by the State of Idaho
Range Hood Vents
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0700303
4030 Molly Dr -Cnty Mech
Cook Stove Vents
Bath Fan Vents