HomeMy WebLinkAboutAPPLICATION - 07-00472 - 9762 S 400 W - MechanicalSep.19, 2007 10:26AM
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CITY OF REXBURG
No. 4919 P. 2
0
MECHANICAL PERMIT APPLICATION Please 0700472
19 E MAIN, REXBURG, ID. 83440 If the que 9762 S 400 E- Manufactured Home
208 -359- 3020 X326
PARCEL NUMBER: ;6 � � j �C ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS: DO 4))
PHONE #: Home c -- 1 Work
CONTACT PHONE #
9
ON CU JG`j I I
Cell
OWNER MAILING ADDRESS: LI A 01 `5 0 N CITY: I u STATE: ZIP:
EMAIL FAX
APPLICANT': (If other than owner)
(Applicant if other than owner, a statement
APPLICANT .INFORM. ,ATION:
ADDRES �) GX � Y^) CITY: L ; " u)
STATE; I 0) ZIP h7 -11Z EMAIL
PHONE #: Home ( ) Work Ct,') ;2 _ X .) q Cell
CONTRACTOR �' 1 rL` S c c� N (,"1 '( N f ITT 1 M L
MAILING ADDRESS: -� - I il) X l CITY %�& � STATE_L� _ZI P 9 L
PHONE: Home# Work# (i : �.t', `� f: >S'. Cell# 'L'
EMAIL
How many buildings are located on this property?
Did you recently purchase this property? LNo j Yes (If yes give owner's
FAX z�;
Is this a lot split ?;NO YES (Please bring copy of new legal description of pro erL OF X URG .11
PROPOSED USE: t tU C� E✓�� �'� t L 1 �� E N C_. t
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under penaity of perjury, I hereby certify that I have
read this application and statc that the information hcrcin is correct and I swear that any information which may hcrcafter be given by me in hearings before the Planning
and Zoning Commission or fire City Council for the City of Rexburg shall be trod" and correct. 1 agree to comply with all City regulations and Stang laws rclating to the
subject matter this application and hereby authorized represcntalivcs of the City to enter upon the above- mentioned property for inspections purposes. NOTE: The
building offs may revolve a pen mval is d rmdcr the provisions of the 2003 Intemational Code in cases of any false statcmcat or misrepresentation of fact in
the applic ,
or on the pl n which the permrproval was based Permit void if not started within 180 days. Permit void if work stops for 180 days_
0 / I / o
DATE
to act as agent for owner must accompany this application)
FAX iv 2?16 r-;1. ")
Do you
jrfff;r to be eontacGedby fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid iru full at the time of application beginning Janaary X. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
Sep.19. 2007 10:27AM
Building Safety Department
City of Rexburg
19 E Main janeilh@rexburg.org Phone: 208.359.3020 x326
Rexburg ID 83440 www.rexburg.org Fax: 208.359.3024
* 5
CIT OF
REX
0&
'•, �.' America§ Family Community
NAME (_; A Y 111 L
PROPERTY ADDRESS C 9 7 �, U
SUBDIVISION M A [)( )PJ C O J N -'� I G (j o
Permit#
Required W
MECHANICAL
Mechanical Contractor's Name: Business Name: RC NC MY W �JtA V I (;
Address City V (, ( - .11 (l G State Zip ' LC
Cell Phone: 6 % Business Phone: (
a-
Fax: ( C6 Z 3 `� -- 1 1 7 Email
Mechanical Estimate S N A (Commercial/Multi Family O
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
I 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
Pool Heater
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) it Coal Fireplace Electric Hydronic
t- • P=
Contractor License number Date
No. 4919 P. 3
The City of Rerburg's permit fee schedule is the same as required by the State of Idaho