HomeMy WebLinkAboutAPPLICATION - 07-00625 - 7613 S 1800 W - Fireplace12/17/2007 15:11 20852346
Ualk iu• LVVI IV:l4HIYI
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Plea
19 E MAIN, REXBURG, ID. 83440 Xf the
208 - 359 - 3020 X326
LEISURE TIME INC PAGE 02/02
0 NA aFao P
0700625
7613 S 1800 W -Clark
PARCEL NUMBER ( We will provide tws, for you)
SUBDIVISION: UNIT# BLOCK #�LOT#�
(Addressing is based on the information - locust be accurate)
CONTACT PHONE # -
PROPERTY ADDRESS J , /� SL`�l�
PHONE #: Home i02) W ( ) Cell ( )
OWNER MAILING ADDRESS: -- CITY: STATE: ZIP:
EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell
�J.PPLlC,4NT: (If other than owner}
(Applicant if other than owner, a swmnent authorizing applicant to act as agent far owner must accompany this application.)
APPLICANT INFORMATION:: ADDRESS My.
STATE; ZIP EMAIL FAX
MAILING ADDRESS: CITY
STATE ZIP
PHONE: Homc# Work# Cell#
Is this a lot split? NO YES (Please bring copy of new legal desmiption of property)
EMAIL FAX
How many buildings are located on tWs propet�y'1 - -
Did you recently purchase this property? No Yes (If yes give owner's name)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments,1k=)Ddc4 daMe, Commercial, Addition, Etc.)
APPLICANT'S SIGNATU `RE, CERTIFICATION AND AUTHORIZATION: Under pmwa y of pcjury, I h=by our* dw I n ave
mod this 2whadca and tuft diet the iadlrmadon herein is arnreat and I swag thal xq k&msdoe which m bet"Aar be given by me in bearings bofmt the Plavning
end Znelag Ceatmlaslaa at the Chy Conppl for the City of R=b%n shall be tied U and == 7 same % comply vlth all City rcoatiom and stw Intl releting to the
subject miter of this fplicadan ad bcnby m9bariad tnpratentddves oftbe City to eater upon the ebovomcadmed May fbr hmpeeflatu per& NOTE: 7be
butlding official mrj evoke a pwafit on epptnvat imied tinder the proviti of the ZOp9 ]ntarnalional Code clean of A0 telse off lu
etnta» eat or misrcpteseutation act
the ep ar approval pay beoot d if not Started **110 18a days. Perait void if work mps for 180 days.
Sign odAppliCant DATE
Do you prefer to be contacted by fax, email r phon�o? Circle One
WARNING — BUXLDING PERMIT MUST BE POSTED ON CONSTRUGTfON SMv
Plan fees are non refuadable and are paid In fau at the ttme of application beginning Jmraarx 200£
Ctty of Ruburg's Acceptance of the'pha review fee does not aoratltnte plan spproanl
12/17/2007 15:11 20852346
jai, Id, 2W 1U;14AM
LEISURE TIME INC
•
NAME
PAGE 01/02
No. 3539 P. 3
Building Safety Department' DoE *"""'�� CITY OF
City or Rexbur 4 REX
A O
79 E mah jwXg1h *raxbvrg otg PhW@. 208.359.3020 x326 Amerrm's rnmiyConnr�e niry
h,
ID 89dd0 www,rexbuSwp 5= 208X9 aW4
''.,. •°
v // / _ .-
Pxo PERTY ADDRESS _ `7 L LS " L YSC
SUBDMSION
Required111 "C "ICAL
Meebanical Contractor's Name: Business Nenne: Li g
Address :M _
Ccll Phone: _ mess Phone: /W) 62PS —L. aj
Email
Mechanical Estimate S
sti (Commeretal/Malti Family Only)
FLyTURES & s1PPlTANC—S COUNT (Single Family Awelling Only) "
. Furnace — Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Meat Pump
Air Conditioncr
Evaporative Cooler
Unit Heater
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Z S r00 %
appliance el. L "JU-P�
lnci=ator System
Boiler
____`__ Pool Heater
Fuel Gas Pipe Outlets ;Including stubbed in or £uthue outlets
Heat (Circle all that apply) Gas OR Coal Fireplace Electric Hydronic
— - Z'_3
Signatu� Lieen C'M Licea9e mmiba p
Mec apical sizine Calc lions must be » mitt "th Plans & ARpheation
Point of Sh2n on DI s.
The
schedule is the sme as raped by the SWe