HomeMy WebLinkAboutAPPLICATION - 07-00538 - 200 S 3421 W - Mechanical10/23/2007 10:16 2085234638
Jar..18. 200710:14AM •
CITY OF REXBTJRG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, M. 83440
208 - 359. - 3020 X326
LEISURE TIME INC PAGE 02/02
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No. 3539 r. 1
Please 07 00538
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Uthegni 200 S 3421 W- Klingler
PARCEL NUMS l l � n � 1 (we wi provide this £or you)
SUBDIVISION: T— UNIT#f BLOCK# I.OT#
(Addressing is based on the information - must beat:cwrate) 4,LA „, i . ,
OWNER MAILING ADDRESS:
CONTACT PHONE # ,�
1.J 4
0
CITY: STATE: ZIP :�
EMAIL FAX
- 3
APPI ZC',� Nom (If other than owner)
(Applicant if otber than owner, a statement antborizing applit Mt to act as agent fDr owner must accompany this eppU"don.)
APPIJCANT INFORMATION: ADDRESS Cam=
STATE; ZIP EMAIL FAX
PHONE 9: Home ( ) work ( ) Cell ( )
MAILING ADDRESS
PHONE: Home# work*
EMAii. PAX
How many buildings are located on this property?
Did you recently purchase tbds property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of propm ty)
PROPOSED USE:
(i.e., Single Family Residence, Muld Family, Apartments, Remodel, Garage, Commercial, Addition, F-M)
APPLICANT'S SIGNATURE, CERTIFICATION AND. A.UTHOR17ATION: under pixy ofpaimy, i Eby wd* tw t bm
read Lids applieaft end state dmt me intormation Herein is nomad tied 1 went that mq bhum tiag wbieb may bth ift be given by me in headogs befom the Planning
and Zmting Commissice or the C by Council for the City of R:atb&q sball be ttu&N end cerrem ] Wee to am* with ell City tsgaludm end St ge laws relating to the
subject ttlat[M of ft application sod baeby mdori=d representatives of the City W elder Woo dta ahovo-mcadonod properly for kgpcodoer pugmm NOTE: 7be
btuldiag offielal may tavoke a pramk w approvel issued vadar tha provisions oftho = bttmnational Code iA pores of ony li�lsa atamtnant or mistepresemetioa trf fset is
14 application or on the pl= on which the permit or approval vas based. Permit void ifaet stoned within 180 days. Permit void ifwo* stops fir 180 days.
S*mture of 0vmer/Applicwt DATE
Do you preft to be contacted by fax, email or phone? Circle One
WARNEq(; — RmPING PERMIT MUST BE POSTED ON CONSTRUCTION SITU:
Plan fees are non- refandable and Are paid to fall at the time of appli"on be0uning J Q,I,
City of Rexburg's Aeceptasee of the plan review he does not eonstitate plan approval
10/23/2007 10:16 2085234638 LEISURE TIME INC PAGE 01/02
Jan. 18. 1007 10;14AM No. 3539 P, 3
Building Safety Department ; ��v� � CITY or
Cay of Rexburg T �� B � G
r
19 E Man kromore0um org Phow. 208.33 .8020 x926 ' +.
R=bn ID 83440 �� // WWW,lex6urg.orM Fcx 20a3P 3W4 '..,..• Anrrla+b F�re,lyGbmm�rriry
FAA
NAME � , `,r
PROPERTY ADDRESS Penniv
SUBDIVISION --
Required!!! MECHANICAL
_ t
Mechanical CortwWr'.s N �— % Business e
Add=s P-c-20) AL) . ( ) _v stag Zip - �
Cell Phone: ( ) Business Phone: 149A 5 0 9 3 - 41 a
Mon I P MAM
Email 1.P e- 0, SrV . Aj-e f
Mechanical Fatimtate S (Commerrlal Multi Family Oaly)
FLXTURES & APPMNCES COUNT (Sbglc FaW1y DweWnZ Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo Dryer Vent
Heat Pump Range Hood Vents
Air Conditioner Cook Stave Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Sp Neater .
corative gas -fired appliance tAD
Incinerstor System
Boiler
Pool Heater
keel aas Pipe including stu m outlets
Heat (Circle all th �Y)G Oil Co lect& Hydronic
Mee A ' AUSizina
Cnlc�ons m�nst
be sub 'tted
wfth Fans & Auolicntion
A
Point of &e very must
be s, hown
on Liana.
License 'Date
The city of a t M is perms: fee sche&7e b the smme as regufred by the L tare