HomeMy WebLinkAboutAPPLICATION - 07-00347 - 4148 Homestead St - New SFR Mechanicalgo C..ITY OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION Please i
19 E MAIN, REXBURG, ID. 83440 If the ques 0700347
208 - 359 -3020 X326 4148 Homestead
PARCEL NUMBER: f _ g
SUBDIVISION: UNi ,,
(Addressing is based on the information - must be accurate)
OWNER: {P/- oL cr" CONTACT PHONE # 7,57- / y80
PROPERTY ADDRESS: V8 h�me S7_e�l� S l •-
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
CITY:
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
PHONE #: Home ( )
Work ( )
Work ( )
Cell ( )
Cell ( )
CONTRACTOR
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 Commit ion 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 applicati d hereby authorized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building offici ay revoke it on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the applicatio ^ n the pl s hich the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
8 i & i d7
nature of / pplicant DATE
EMAIL
STATE: ZIP:
CITY:
IM
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 jonellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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CITY O F
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Americo Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: 40� � ` � Business Name: :YA ��� 2Z G
Address 64 tu4l� K- G; e'de- City r(7 State zip e_
Cell Phone: (?OE�) 3 0S0 S - Business Phone: ( )
Fax: (fig) 356 &!� Email -s ^ saw Ae ri_,j IKE; ,,
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace I Exhaust or Vent Ducts
JV ` aC f
Furnace /Air Conditioner Combo ` c Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
j Decorative gas -fired appliance d ��
Incinerator System
Boiler
Pool Heater
Range Hood Vents
Cook Stove Vents
3 Bath Fan Vents
other similar vents & ducts:
w. fl-rer J4 e 4 ,—er 1/ 0__J
�j Fuel Gas Pipe Outlets including stubbed in or future outlets 1 "/ 10
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
1 2 „A Point of Delivery must be shown on plans.
Signature o Licensed Contractor License number Date