HomeMy WebLinkAboutAPPLICATIONS - 07-00339 - 3361 Lombardy St - New SFR MechanicalCITY OF UXBURG , PI •
MECHANICAL PERMIT APPLICATION Please coi 07 00339
19 E MAIN, REXBURG, ID. 83440 If the question 3361 Lombardy -Cnty Mech
208 - 359 -3020 X326
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE #_
PROPERTY ADDRESS: .--
PHONE #: Home ( ) X ` YS� Work ( } Cell
OWNER MAILING ADDRESS:
EMAIL
CITY:
WNW04/
STATE: ZIP:
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 0 , &O X CITY: h
3 - - 1% ?
STATE; ZIP Y `' y EMAIL - ! F *J 5"�2
PHONE #: Home (tf) LeL- Work Cell( ) �- f✓
CONTRACTOR
MAILING ADDRESS: ?CX 4 �-, 1 7 CITY ' , _STATE _T0 ZIP ,U 5 G
PHONE: Home# Work# P1V< * C& Cell#
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p FAX e5 t7
How many buildings are located on this property? /
Did you recently purchase this property? (P Yes (If yes give owner's name)
Is this a lot split ? &; YES (Please bring copy of new legal description of property)
PROPOSED USE: � r,JG ` I,k C �'
(i.e., Single Family Residence, Multi Family, Apart(nents, 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 tate 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 Commis ' n 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 a ication and authorized representatives of the City to enter upon the above- mentioned property for inspections purposes. NOTE: The
building official y r oke a pe t on gpproval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application o ,,on a p). is which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
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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 ` w
19 E Main ianellh@rexburg.org
Rexburg, ID 83440 www.rexburg.org
NAME Jaeger Construction
PROPERTY ADDRESS _3361 Lombardy St
SUBDIVISION
Phone: 208.359.3020 x326 " Wil
Fax: 208.359.3024
Permit#
C I T Y O F
REXBURG
OW
Americas Family Community
Required!!! MECHANICAL
Mechanical Contractor's Name: Steve Dick Business Name: High Country Heating
Address P.O. Box 627
Cell Phone: (208 ) 709 -4650
Fax: ( 208 ) 745 -0817
State Idaho Zip 83440
Business Phone: ( 208 ) 745 -8056
Email highcountryhtg@netscape.com,
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace 1_ Exhaust or Vent Ducts
1 Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
1_ Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
2_ Dryer Vents
Range Hood Vents
Cook Stove Vents
3_ Bath Fan Vents
other similar vents & ducts:
6_ Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that applA::Q " it Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
City Rigby
_Steve Dick _ 6068 _7- 31 -07_
Signature of L' nsed Co tractor License number Date