HomeMy WebLinkAboutAPPLICATION - 07-00446 - 1743 N 4000 W - Mechanical09/17/2007 08:53 2086243774 HOUSLEY PUMPS INC PAGE 03
CITY OF REXBURG
:: ! AMCAL PHRMIT APP LICATrON PICA 0700446
?. [9 E MAIN, RMURG, ID. 83440 lame 1743 N 4000 W -Cnty Mech
208.359.3020 X326
PARCEL NUMBER r� I tvl ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOTS
(Addressing is based on the inforn►atlon - must be woof rate)
CONTACT PHONE # # -2 a - - 3 g g - y s�
PROPERTY ADDRESS:
PHONE #: Homo ( ) . f*. J�&Z Work ( ) Cell ( ) _X2/ - Oo S
OWNER MAILING ADDRESS: A/ �U W CITY: yh geg�_STATE;;ra/_ZIP :_&VV8
EMAIL FAX
APPI1 (If other than owner) -
(Applicant If other than owner, a statomcro ststhorfrlttg s licant to act as agsat lbr owner mad accompuy
APPLICANT INFORMATION; ADDRESS e(0 W M " — CITY: a
STATE, .mod _ ZIP g,,3qqc EMAIL_ FAX
PHONE #: Home ( ) Work Parr (gay- 3 77dd Coll( )
MAILING ADDRESS:
CITY STATE ZIP
PHONE: Homo #_ — Work# Cell#
EMAIL FAX
Hove many buildings are located on this propalty?
Did you recently purchase this propertlfl No Yes (If yes give owner's mane) A )
Is " A lot split? NO YES (Please bring copy of new legal description of propeity) A/ /its
PROPOSED USE: >� "
Ux, Sioals Family Retsidom.
Additim Etc.)
APPLICANT'S SIGNATURE, CF,RTIFICATION AND AUTHORIZATION: tlrwr waRy orwwy, l hereby certify tho 1 have
Nadi Nis epjtlaelioe No inns" adorstdw heroin is ramot end 1 swcsr by toe bo b ovinp b.bro t�,o vls�=s
Ina za,ins CaenmtnM or 01e City Cmmcil fur ft City edReubw6 shall be vul kbul std awat..1 wu a eow with all City wlplWON ad Bests Ian Misting to 6e
wbim mater of this svDlfation end bmby vAbotimd rweesntativa of Ma City to utter ups+ ste ebo 4mmioasd prop" o Or IftMotlow Puma. N= The
buildbi ot'1l W may wok a permit w eppMW inued eta da Ote prove *m of the 2003 a m awd Cost In usis of say I&W stamtma or oa of *a io
tai or tie+ the p leas oe w or approval time baud peealt void If not tWWd wi tfo 110 days. Permit vold If work stops far 1e0 dt
Cr / ZZI 0 7
Stpaturs ofOwtwoAppllcaat DAkTH
Do you pmfer to be comeW by fif C1rak Ono
WAIWnVC — H MUIIT 09 YVSTWLD ON CONIlTIRUCTION WTV
plan fees are moe- ntetesdabis tied ere paid ie fall at the tiese of application espleelsp AWAL12jo—M
City of N4zWrf'e Aesaphace of We plea review f« loss not eoeslNetlie plan approval
09/17/2007 08:53 2086243774
Mar. 1i. 2M 3:39PM e
e
,, Building Safety Deparfinenf
,.. Cily of R"bLmg
19 E Math Ia�leNhlisltbvy.o� P hww. 2ft. %S'➢.X20 XM
Rerbwp V 03110 w ill: 20L$j9 -vU
PAGE 02
N). 353? P. 3
CITY OP
RM
'� �� � r dMif/imt }brfly Co,a�egK{q
NAME
PROPERTY ADDRE
SUBDI SION
Pertnitg
Requiredlll
MECHANICAL
Mechwdcal Contractor's Name: Busies Name: m I C"e ,
Address�U {�11Giy1 City State lap
Cell Phone: (Vog') 320 — 63 1.3 Busims Phone: Ooe ) U.?Z-
Fax: (0208' ) may_ - 3 7 7 !� ElYtail
:Meebanical ts"ate 5 Famijy Only)
-FATURM & APPMNCES COUNT (Smelt F'a Wly D* elrtg 0*)
-�-- Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Yump
Air Conditioner
Evaporative Cooler
Unit Heater
Spacc Hcater
Decoradve gas -$red appliance
Incinerator S
Boiler
HOUSLEY PUMPS INC
Dryer Vents
Rangc Hood Vona
Cook StAVe Vents
Balk Fan vmu
other similar vests & ducts:
Pool Heaw
2 Fuel Gas Pipe Gull rouilu dng stubbed in or future outlets
Heat (Circle all that apply) Coal Fireplace Electric Hydronic
t/ r � _;! 1 I,,l i r� .1 r .. r n It '1► �� r ! r.. 1 1 __ L,� ,
lcz;L�' Y4 9�10 0 z
Slpiture of Lia msed Codisdor 7 L:se uumb4r
whol is the some
Idaho