HomeMy WebLinkAboutAPPLICATION - 07-00310 - 4986 S 2000 W #25 - Mechanical0
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the qu
208 - 359 -3020 X326
PERMIT #
a
0700310
PARCEL NUMBER C�� I
SUBDIVISION: 1. 1 rr
(Addressing is based on the information - must be accurate)
4986 S 2000 W #25
1JLV\.11tY L" 11t
OWNER: &,TA V k�"vf , CONTACT PHONE # 3SIo• X 6 $3
PROPERTY ADDRESS: qq %k S JU10 JAX4 -0-- 2,5
PHONE #: Home (LCF6) 3St, 3 B Work (2-t9) 3 i- 3O Cell 00) k 3;.S7/ - X 17-5
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OWNER MAILING ADDRESS: U(9 21pU) -4 CITY: E X6.1, c STATE: 17b ZIP: 553y
EMAIL 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
STATE
ZIP EMAIL
PHONE #: Home ( )
Work (
CITY:
FAX
Cell ( )
CONTRACTOR 4- R eJ c-
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
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 property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalt of perjur 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 r,Trecentnfinn
the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. P oie wp ST 118yayE
F IDM - T E
Signature o f Owner /Applicant Do you prefer to be contacted by fax, email or phone? Circle One L 1 0 2007
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTR CTI !
Plan fees are non - refundable and are paid in full at the time of application beginning
City of Rexburg's Acceptance of the plan review fee does not constitut plat tT (5F R EXB U R G
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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CITY O F
REXB
America's Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address
Cell Phone: ( )
Fax: ( )
Business Phone: (2bg) 3S �,. y I
Email
Business Name:
City State Zip a
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES 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 Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater,
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including 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
schedule is the same as
Date
by the State of Idaho
MECHANICAL
License number