HomeMy WebLinkAboutAPPLICATION - 07-00353 - 140 S 5000 W - New SFR Mechanical•CITY OF REXBURG 0700353
MECHANICAL PERMIT APPLICATION Ple, W.
19 E MAIN, REXBURG, ID. 83440 If thi 140 S 5000 W -Cnty Mech able
208 - 359 -3020 X326
PARCEL NUMBER: - W(1)W9 n�(& ( We will provide this for you)
SUBDIVISION: I UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: 7'i *m 67i5skr CONTACT PHONE # 54013 -
PROPERTY ADDRESS: 1 ,110 5 -�r,k sm m° , e- 5 , 7 -
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
FAX
CITY: e< STATE : Z*!_'> ZIP: '&3 4
APPLICANT (If other than owner) LLC
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 30 5cpceM �' =`���i CITY: ,or
STATE; ZIP ef3, EMAIIeW;11.,?8 i,• X �Slv 1S /�
PHONE #: Home (
Work ( ) Cell (
Work ( ) 3 /3 - ?Wl Cell ( ) 3/3 o? W1
CONTRACTOR SGc.
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?« N� C Yes (If yes give owner's name)
Is this a lot split? 4!�V 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 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 o nth lans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signs e of Owner /Applicant DATE
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 ionellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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America's Family Community
NAME T( o-.n E <s s
PROPERTY ADDRESS
SUBDIVISION � c?.
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: J w XF Business Name:
Address 2 7 y a 3 122 L „I City e j ��e State 1- > Zip Fs 3 Y Yo
Cell Phone: ( ) 3 Cb Business Phone:
Fax: ( ) 3 C7,d � Email ) L f�1ra )� Co ,"_
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace 1 ; Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
1 Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
other similar vents & ducts:
A Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) as Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
"1 , /Toint of Delivery must be shown on plans.
of icensed Contractor Lic e number Pate
Dryer Vents
Range Hood Vents
Cook Stove Vents
3 Bath Fan Vents
T he City of Rexburg's permit fee schedule is the same as required by the State of Idaho