HomeMy WebLinkAboutAPPLICATION - 07-00448 - 2760 W 1000 N - MechanicalSEP -17 -2007 MON 11:04 AM FIRST CALL JEWEL FAX N0. 12085292793 P. 02
Jul. i�. im z:iinve • -
CITY OF RM URG9
BUILDIN PERMIT APPLICATION Pie 0700448 l
1 9 E MAN, REXBURG, ID. 83440 r tx 2760 W 1000 N- Wadholm 'e
208 - 359.3020 X322
PARCEL NUMBER: we wni proviae uns for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the f.afotmation - must be aocurste)
CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Hotmc ;?14 Work ( ) Cell ( )
OWNER MAILING ADDRESS �' CITY: STATE• . ZIP:,L� d
EMAM FAX
r1PPLICAIVT (If other than owner)
(APPS if other thaw owner, a statement
to act as agedt far owner most accompany this
APPLICANT INFORMATION: ADDRESS -� CITX:. / //,5
STATE; r ZIP EMAIL FAX'- 7
PHONE #: Home ( )�- ; Work (
MAILING ADDRESS: A • �0 .�� CITY.
PHONE: Home# Work# Cell#
many btuldims 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 (PIease bring copy of new legal description of property)
PROPOSED USE:
(i,e., $We Family ?.Wdence, Multi Family, Apa= tom, RemodA Gara`e, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION ANM AUTHORIZATION: uaderpesaltyafpedwy lhmbycerafythatl
have reed dais appliratlaas Gad atase dwt ttte isforrnadaa hamio is cvnoui and I awosr that Gay iufuaustioa Which may havaft bt Evan by roe in hearings before tiro
pima 9 ®d ZamiAg Commiplou of the City Cow 1 h tba City of Razbwg shag bs amh1W and caasot. I ague to comply whb in City regalatioos and State laws
m1oting to rho sub)aot matter of t b oppiication and hoteby eurhortaed rapteucunsw of trio City to onmr upon the Above nwmt0000d DtopcssY ft hwpoatioats purpn:w.
NOTE: The building odioiai Wray revoke a pant on wpmvd issued under ft provisi= of die 2000 Iamrttadood Coda in omm of xW felao namo or
ndteeprweatatiao of itCt.lo the appJk�lon ar oa tbo Dlaas as wblolti dv parntit of approval woe based Permit void if not &Wed withi+t 120 days. FmWt void if wart:
Ii
DATE
Do you prcfer to be contacted by fax, email or phone? Circle One
WAIRM0— M=ING POWT MOAT= POaTIiD ON COMTAUCTMN 9ITE1
Plan fm an Gant- relhndaW asd as paid In W at the nma of spell sdm b*nloda9 �t
Clky of Asssbwes Aaaeptmm of the pism rsrlell flea deoraot can dtut*P1ft spproral
3
SEP -17 -2007 MON 11:05 AM FIRST CALL JEWEL FAX NO, 12085292793 P. 03
. 1ea3e complete thesti Applic atio n ! u the question does not Apply 0 in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
RequiredW
MECHANICAL
Mechanical Contractor's Name: usinoss Name: 1 Ld
Address city zip
Contact phone: ( ) �'�-727 _ Business Phone: ( )
Email Fax
Medeuiew Estimate S (Commercial/Multi Family Only)
FIXIITRES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vcnt Ducts
1� Furnace/Air Conditioner Combo Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Raugo Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents ducts:
Space Heater
Decorative gas-fired appliance
incinerator System
Boiler
Pool Seater
Similar fixtures or Appliances
Fuel Gras Pipe Outlets including stubbed in or future outlets
Inlet pressure (Helot Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Replace Electric
Mechanical Stang Calculations must be submitted with Plana & Application
Point of Delivery must be shown on plans.
s igoatuto or Lic&sk Connaebar r Ljoc so neiber
Ths Clry 4i• bwR 's_PdM$rf6e .;d r ale is the sans as required by the of ldoho