HomeMy WebLinkAboutAPPLICATIONS - 07-00341 - 2550 S 4000 W - New SFR MechanicalREXBURG •
CITY OF 07 00341 1
MECHANICAL PERMIT APPLICATION Pleas
19 E MAIN, REXBURG, ID. 83440 If the qt 2550 S 4000 W- Sanderson e
208 - 359 -3020 X326
PARCEL NUMBER: C�5N R t We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS
PHONE #: Home ( Cu Work Zell Ocs -3G51 _ L4
V C U ' CITY: J f, U
` i 7, 1 STATE; ZIP:
OWNER MAILING ADDRESS: � ` �^
EMAIL FAX 3 CA - -
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 CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) )
CONTRACTOR _>�
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property r } U Y 1 Ci -
D''e 0 L4
Did you recently purchase this property? No es If yes give owner's name)
Is this a lot split? , / � YES
PROPOSED USE: "- )( rV
(i.e., Single Family Residence, Mill
(Please bring copy of new legal description of property)
Ie J?lM t � \_4 V_e�? i A e;n Cc
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 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.
Signature of Owner /Applicant DATE
Do you prefer to be contacted by fax, email or one? ircle One
WARNING — BUILDING PE 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
C-,//1 n l4 P, i'?-X ;Yl CONTACT PHONE # _f
Building Safety Department 14W ��QFAkXBUA�,e
City of Rexburg m
19 E Main janellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
CITY O F
REXB
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America's Family Community
NAME WI V f C1
PROPERTY ADDRESS 4<= UJ ' �,t✓`F C�:r2j Permit#
SUBDIVISION rj/(� k
Required!!! MECHANICAL
Mechanical Contractor's Name: Business Name:
Address 3 Y� City State
Cell Phone: ( ) _� j c ; D4 /5 Business Phone:
( ) 313G�
Fax: (
77 S5 1 62 Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwell' Only)
Furnace Exhaust or Vent Ducts
l� Furnace /Air Conditioner Combo �?j �( Dryer Vents 6
Heat Pump
X Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
E_ Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
other similar vents & ducts:
11 _ Fuel Gas Pipe Outlets including stubbed in or future outlets I Gj 10
Heat (Circle all that apply) as JOil Coal Fireplace Electric Hydronic
Mechanical Sizine Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Icensed Contractor License number
The City of Rexburg's permit fee schedule is the same as
Date
by the State of Idaho
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
Zip