HomeMy WebLinkAboutAPPLICATIONS - 07-00496 - 77 Douglas Dr - Fireplace10/03/2007 14:16 2085234638 LEISURE TIME INC PAGE 02/02
Dan, IU. CVVI IV; 14AM • No. 3539 P. 2
CITY OF REXBURG
P]
0700496
MECHANICAL PERMIT APPLICATION Please col
19 E MAIN, REXBURG, ID. 83440 Nthe gnestiam
208- 3S9 - 3020 X326
PARCEL NUMBER (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the infonnatioa - must be a=erate)
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PROPERTY ADDRESS: /L� /
PHONE #: Homep • '
OWNER MAILING ADDRESS: C
EMAI FAX
( ) Cal] ( )
Cam: STATE: ZIP:
C N7 : (If other than owner) - - -
(Applicant if other than owner, a sratcmetlt author applicant to act as agent for owner M ust accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; Z.IP EMAIL FAX
PHONE #: Home ( ) I.. Work ( ) Cell (
=7 PA CT
MAILING ADDRESS ITY _,Jdah 'RkATS.,W
ZIP
P HONE:
• 11
� z � I f`
EMAIL —FAX
How many buildings are located on this property?
77 Douglas Dr- Croasmun
Did you recently purchase this property? No Yes (If yes gave owner's naM
Is this a lot split? NO YES (Please bring copy of now legal description of property)
PROPOSED USE:
(La,, Single Family Residence, lV Wd Family, Apartments, Remodel, daraga, Commercial, Addition, Pte.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION. under p=ft ofpajvW, l hereby � dies 1 have
revs fib spal Fmon and ffm tbat rbe inr0im w harm is Go = an d 1 SWM that am ho mwos which ft* t I I I a be 6M S9 me in heaffiv before the y the ttg
and ZaateQ Cottmtlsslan or the Cigr Conic l for *a City of Rexburg shalt be "M MW corneeL I to =M* with 14 QW xqFW= an d Stets taws rolftg to the
subJect master of4ds applicmlon ad haoby mrftrized mpmmnwves oithe City m tam upon ow ebova nocmioned pmcrw for b veca s mom- Nam. The
buff to ofeial may rmix a yc mit oo approves leased m eet the provlsieoA of the 200 kt raWonal Colo in emn c(aoy thlse moment of mlerapnesentaion of }bet in
the wlia6on or on the plans on wbleb the pemilt cr approval was based. Permit vold if trot Surfed within 180 days. Permit Vold if work stops for 180 days.
,7%mcu►n u4 vwu
pA7T
Do you prefer to be contacted by fax, email or phone? Cirole One
WARNING — RU LDING PERMIT MWT BE PWTEA ON CONSTRUCTION MM,
Plan fees are non - refundable And are paid In fW] at the time of application beemning j . 00.£
City of RexburgrR Acceptance of the plan revlew fee dow not eo>tstitute plan approval
10/03/2007 14:16 2085234638 LEISURE TIME INC
Jan- M lUU/ 1U:14AM
Building Safety Department
MY of Rexburg
PROPERTY Al
SUBDIVISION
r9 E main )ane11h&0xbwg org Phone; 208.359.3020 x326
Rexburg ro 83440 www.mxbuQ.or�► FrnC 208,339:3Q24
.-.-
PAGE 01/02
NO. 3539 P. 3
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Requiredlll MECHAAWAL
Mechanical Contractor's Name• Business Name: 1,
Address i fate Zip $L�
Cell Phone: ( ) Business Phone: on
Fax: Mo (- (� �J�- y
Email -1 � � ' 01C� (^ l� �, �'�, '•
Mechanical Estimate $ (Contmereisl/1Vluttt Fang► Ouly)
FXXTURES & APPLIANCES COUNT (Single F&W y► Dwelling Duly)
Furnace Exhaufit or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
.� Decorative gas -fired appHmce
Incinerator System
Boiler
� Pool Heater
Dryer Verna
Rance Hood Vents
Cook Stove Vents
Bath Fan Venus
Other similar vents & ducts:
Fuel Gas pipe Oudeb including stubbed in or futm outlets
Heat (Circle all that app1Y) Gas Oil Coal Fireplace Electric Hy&onic
Pnint ns ~" u 9t a sh 1t 0 - 8 - lan�
�� 7 7g' D �
sehadxt'e Is Ow mne ar regWmd.by the State