HomeMy WebLinkAboutAPPLICATION - 07-00615 - 5496 S 2000 W - Gas LineCITY OF REXBURG •
MECHANICAL PERMIT APPLICATION Please i
19 E MAIN, REXBURG, ID. 83440 If the ques
208 - 359 -3020 X326
s
0700615
5496 S 2000 W- Foster
PARCEL NUMBER: 1 ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
UW1V,R: , l// W r�°�'' �� CONTACT PHONE #
PROPERTY ADDRESS: 5
PHONE #: Home Work ( )
OWNER MAILING ADDRESS: 5 ~L. CITY:
EMAIL
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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
STATE:
PHONE #: Home (
STATE: ZIP:
CITY:
1
Work ( ) Cell ( )
CONTRACTOR
MAILING ADDRESS: C TY STATE i4/ 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 USI✓:
(i. ; Single Family residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
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APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of perjury 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 appfi ation and hereby authorized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building official ay re ke 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 n e plans on whit the unit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
01
Signature of Own / pplic DATE
Do you prefer to be contacte0y 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
ZIP EMAIL
Cell ( )
Building Safety Department
City of Rexburg
19 E Main ionellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Mechanical Contractor's Name:
Cell Phone: )� �fl�O Business Phone:
Fax: 5 � — 2dt ----J` Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
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 �
rte/
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply Gas QkI Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & A
Point of Delivery must be shown on plans.
�4'
of Li se ontractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Name-
State /�
C I T Y OF
REXBURG
Americas Family Community
A Required!!! MECHANICAL -