HomeMy WebLinkAboutAPPLICATION - 07-00544 - 856 Heritage Rd - New SFR MechanicalCITY OF REXBURG 0 1 •
MECHANICAL PERMIT APPLICATION Please cc 0700544
19 E MAIN, REXBURG, ID. 83440 If the questic 856 Heritage R
208 - 359 -3020 X326 g d- Miller
PARCEL NUMBER - � ' ' �� (We W111 Yruviuc WIN ivi YVU)
SUBDIVISION: ark 4 r i f, 4 s UNIT# BLOCK# _LOT #__7
(Addressing is based on the information - must be accurate)
OWNER: t 0V L. / to i / CONTACT PHONE # 201 4a0 r
PROPERTY ADDRESS: QC-
PHONE #: Home (2o?) 201 440 Work (Z,)F) 5t 9! '/$73 Cell (zof) 20/ - /e0
OWNER MAILING ADDRESS: 56 d er. /4 P CITY; nx�u STATE: LP ZIP: I
EMAIL 4/11 P11 C - 1.1914 • 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 CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home (
Work ( ) Cell ( )
CONTRACTOR
MAILING ADDRESS:
PHONE: Home# Work#
ee
CITY
Cell#
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property:2gj� Yes (If yes give owner's
4
OCT 2 6 2007
Is this a lot spli'_N_b_P YES (Please bring copy of new legal description of property)
PROPOSED USE: S 11 /e k s IJr.."c
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjur I hereb certif 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 application or on the plans on whicl e permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
k If
0 / 2G / o
of O er /Applicant DATE
prefer to be contacted by fax, email r pho n ' Circle One
WARNING — BUILDING PE IT 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
i
Building Safety Department U r.
City of Rexburg —
RE UR 19 E Main janellh @rexburg.org Phone: 208.359.3020 x326 America' amilyCommunity
Rexburg, ID 83440 www.rexburg.org Fox: 208.359.3024
NAME r
PROPERTY a d Permit#
SUBDIVISION �r� r••.! Er �f� t
Required!!!
MECHANICAL
Mechanical Contractor's Name: 0W new Business Name:
Address City Ax4lZ State 2,� zip-
LOD
Cell Phone: (2or) 261 - 6'oo L Business Phone:.{ 4Zd
Fax: tI 1,4 Email / /Yr /L
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
2 Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Dryer Vents
Range Hood Vents
Cook Stove Vents
_ Bath Fan Vents
other similar vents & ducts:
4 e54 Aecwe, j — C 7, -,,,, k 1 -tr
app "A /Z S
4 . Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) as it Coal fireplace Electri ronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Of L i eens e d G@R4a ctor
04�i1r/'
The City of Rexburg's
10 ae
License number Date
t fee schedule is the same as required by the State of Idaho