HomeMy WebLinkAboutAPPLICATION - 07-00443 - 3342 N Salem Hwy - FireplaceCITE' OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION Pleas
19 E MAIN, REXBURG, ID. 83440 If the q 07 00443 le
208- 359 -3020 X326 3342 N Salem Hwy- Harris
PARCEL NUMBER: �3� (
SUBDIVISION: LINT I It
(Addressinp, is based on the information - must be accurate)
CONTACT PHONE
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PROPERTY ADDRESS: 3 ;; cl� AZ
PHONE #: Home ( ) -Z Bb Z-Z. Work
OWNER MAILING ADDRESS: .5�m� _ CITY:
EMAIL
FAX
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
STATE
PHONE #: Home (
Work (
Cell (
Cell (
CITY:
FAX
CONTRACTOR Glee
MAILING ADDRESS: /Rv `/ Oee ;)Cov CJ CITY )6 � STATE ./0 0 e ZIP yVtJ
PHONE: Home# Qo ,gam Work # ,25� Mdv Cell # �?y7 y /7®
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this propert No es (If yes give owner's name)
Is this a lot splitl:��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 hereb 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 revo ' a permit on app val issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or o the lans on whic ermit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Si ature of e lican DATE
ZIP EMAIL
&11 p
Do you prefer to be contacted y 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 ianellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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REXBURG
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America's Family Community
NAME
PROPERTY A RESS ,_-cif Permit#
SUBDIVISION
Required!!! MECHANICAL
Mechanical Contractor's Name: ,�✓f� !s1✓ Business Name :� PP ,
Address City �� State / Zip
Cell Phone: Business Phone:)
Fax: ( ) Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Pool Heater
L Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Co4f Fireplace lectric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho