HomeMy WebLinkAboutAPPLICATION - 07-00428 - 824 Heritage Rd - New SFR MechanicalCITY OF REXBURG •
MF,CHANICAL PERMIT APPLICATIOT 07 00428 Aication!
19 E MAIN, REXBURG, ID. 83440 Dn applicable
208 - 359 -3020 X326 824 S Heritage -Clark
PARCEL NUMBER:
SUBDIVISION: q�;\n � a A UNIT # BLOCK# _ LOT#
(Addressing is based on the information - must be accurate)
CONTACT PHONE # ` 1,?,' '? � C
PROPERTY ADDRESS:
C tvOcjow: � om & , Kv W C. &o
PHONE #: Home Work ('�) t Cell(
OWNER MAILING ADDRESS: STATE:�,F j <' i
EMAIL � �� S'� l V 1 � FAX
APPLICANT (If other than owner) ,, ti )U t
(Applicant if other than owner, a statement authorizing applicant tb act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home ( )
CONTRACTOR 0 Lo
MAILING ADDRESS:
PHONE: Home#
Work (
Work#
EMAIL
FAX
CITY:
FAX
Cell ( )_
CITY
Cell#
TESEP 1 RIB. N
CITY OF RE XBURG
How many buildings are located on this property? 4
Did you recently purchase this property? No 'e ) (If yes give owner's name)1
Is this a lot split. NO) YES (Please bring copy of new legal description of property)
PROPO c� Ri vt
(i.e., Ingle Family Residence, Multi Family, Apartments, Mmodel, 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
ildmg official y 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
e ion o on a plans on which the p r val was d. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signat a of er /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 VxBVR��
City of Rexburg �y o
s�
19 E Main janellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
CITY OF
REXBURG
America's Family Community
PROPERTY A DRESS Permit#
SUBDIVISION
Required!!! C,,W f ;.�_XECHANICAL
Mechanical Contractor's Name: ef Business Name:
Address Z �� �; �� City State -L Zip'
Cell Phone: (Z�; ) ��, Business Phone: Qog)
Fax: ( ) Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
1 Dryer Vents
Range Hood Vents
Cook Stove Vents
_ Bath Fan Vents
other similar vents & ducts:
Space Heater
Decorative gas -fired appliance
Incinerator System J
Boiler
Pool Heater
r1
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Apulication
Point of Delivery must be shown on plans.
a -,, � �- " '/ c 1'�' C) W �" , C (�q If o /0' -�
Si tune of Licensed Contractor ° License number D to
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho