HomeMy WebLinkAboutAPPLICATIONS - 07-00489 - 1977 N 4000 W - MechanicalC
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MECHA'PERMIT APPLICATION
19 E MAIN,TEXBURG, ID. 83440
208 - 359 -3020 X326
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Plea 07 004 89 a[
If the( 1977 N 4000 W- Hendricks )le
PARCEL NUMBER: k R (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE # a C- - 5 S � -
PROPERTY ADDRESS: J
PHONE #: Home (c +c) 35 t, Work (-g v;-) Cell % C 75' 7
OWNER MAILING ADDRESS: /� �7�r y v UVG� CITY: ex brrr . STATE ZIP: e3Y�
EMAIL FAX
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
STA
PHONE #: Home ( )
Work ( )
Cell ( )
CONTRACTOR `
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings 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 (Please bring copy of new legal description of property)
PROPOSED USE:
ZIP EMAIL
CITY:
FAX
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalt of perjur 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
building official may 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
the appjiegon or on qx7plans on whtgl9Ue- Rerrgt'or approval was bajed. Permit void if not started within 180 days. Permit void if work stops for 180 days.
/ / / Z
DATE
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 yoaExeUR�,o
City of Rexburg 'y
19 E Main janellh@rexburg.org
Rexburg, ID 83440 www.rexburg.org
NAME
( - V
PROPERTY ADDRESS
SUBDIVISION
C I T Y O F
REXBURG
ity
07 004 89
1977 N 4000 W- Hendricks
Required!!!
Mechanical Contractor's Name:
Address
Cell Phone: ( )
Fax: ( )
Business Name:
State
Business Phone: ( )
Email
Zip
I Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
1 Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
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 & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The City of Rexburg's
schedule is the same as
Date
the State of Idaho
MECHANICAL
License number
City_
0c t, 1. 2007 12: 54PM No. 4999 P. 2/2
Building Safety Department
City of Rexburg
19 a Main Jane)1h *rexburg.org Phone.
Rexburg, 10 89440 www.mxburg.Q Q
NAAIJF-
PROPERTY ADDRESS l9 - i 1
SUBDIVISION
C ITY OF
REX
fty
07 004 89
1977 N 4000 W- Hendricks
Requiredlll
AMCHANICAL
Mechanical Contractor's Name: � �yTo c/ �n YAu ,o d Business Name: K LAar a 1" 4
Address P - &2 75 City L, 6 c! R G State c( zip
Cell Phone: (26 c) 3 fs 6 Business Phone: (zeg) 3 7 7 a
Fax: (z6 �) 3 S1 - k 77 6" Email
mecbavical Estimate S (CommerciaUMuhi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
1 Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Neater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Dryer 'Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & duets:
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outicts
Heat (Circle all that apply) Gas 03.1 Coal Fireplace Electric Hydronic
, Sizing Calculslloins must be su mined with Plans & Apph�,
Point of Delivery ,mus be shown on DIap
Date
The City afRarburg's permit,fee schedule is the same as
the State
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