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HomeMy WebLinkAboutAPPLICATION - 07-00571 - 4519 Timberline Rd - New SFR MechanicalCITY OF REXBURG MECHANICAL PERMIT APPLICATION Pleas 0700571 n ! 19 E MAIN, REXBURG, ID. 83440 If the i 4519 Timberline Rd -01 sen ble 208 - 359 -3020 X326 PARCEL NUMBER: 1 � (We will provide this for your SUBDIVISION: . 6 UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) d'vv�_ CONTACT PHONE # PROPERTY ADDRESS: PHONE #: Home ( ) OWNER MAILING ADDRESS: EMAIL ( T, L S� Work ( ) CITY: FAX Cell ( ) STATE: ZIP: APPLICANT (If other than owner) tW41, CI 8[ - LL- C_ (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS gel (e) `P1 qVg CITY: l P STATE; 1 ZIP �j3 VJ EMAIL & 0k 11eWS A` " "_ 5 --576 P� r 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 give owner's name) Is this a lot split? AQ YES (Please bring copy of new legal description of property) PROPOSED USE: �t r'^^"' (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 r9 *e 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 a fans on which the pyrnit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. Signature of Owner /Applicant DATE Do 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 City of Rexburg �� m a 19 E Main ionellh@rexburg.org Phone: 208.359.3020 x326 �. Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 CITY OF REX BURG Americas Family Community NAME � ,� 0 l S Wv PROPERTY ADDRESS z[ LL c 7 N r2 �© Permit# M 0 - b 10 7 SUBDIVISION _ce--0,2, Required!!! MECHANICAL Mechanical Contractor's Name: Business Name: _ Address 1 -11,8 q S City LE State Cell Phone: ( ) 7 L f. — 2 -8g 4 Business Phone: ( ) Fax: ( ) Email Mechanical Estimate $ (Commercial/Multi Family Only) Zip 4YG FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace T Exhaust or Vent Ducts Furnace /Air Conditioner Combo Dryer Vents Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas -fired appliance Incinerator System Boiler Pool Heater Fuel Gas Pipe Outlets including stubbed in or future outlets Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Heat (Circle all that apply) Gas it Coal Fireplace Electric Hydronic Mechanical Sizing Calculations must be submitted with Plans & Auulication Point of Delivery must be shown on Dlans. Sigrilture of Licensed Contractor License number Date The City of Rexburg 's permit fee schedule is the same as required by the State of Idaho