HomeMy WebLinkAboutAPPLICATION - 07-00627 - 561 Island St - New SFR MechanicalCITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please
•
0700627
19 E MAIN, REXBURG, ID. 83440 If the qui
208 - 359 -3020 X326 561 Island St -G
PARCEL NUMBER f W LY-4,f—ON 00�D ( ,v u will provide this for you)
SUBDIVISION: I UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
VtY1VCl(: �^ tl Q �.
PROPERTY ADDRESS: S6 J T� S lm..,
CONTACT PHONE # - ,3 6 0
S tv t.Jl
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: /7?/ _ CITY: e b&,,, STATE ZIP:
EMAIL FAX
APPLICANT (If other than owner) „ a. a 1
(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 39 37 l o? y 0 t CITY i a L� STATE ZIP 33y4t! Z
PHONE: Home#
EMAIL
Work# '2 1 15-7 02t Cell# ?, _7 o ;� (
FAX
now many nullamgs are located on this property'?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? YES (Please bring copy of new legal description of property)
PROPOSED USE: "oft.. t L4
(i.e., Single Family Residence, Multi Pamily, 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 revoke a permit on approval issued under the provisions of the 2003 hiternational Code in cases of any false statement or misrepresentation of fact in
the applicat�n theilans on h t epermit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
of
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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 Januarp 1, 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
Building Safety Department
City of Rexburg
19 E Main
Rexburg, ID 83440
NAME
PROPERTY ADDRESS
SUBDIVISION
janellh
www.rexburg.org
Phone: 208.359.3020 x326
Fax: 208.359.3024
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C I T Y OF
RE.111.XBURG
America's Family Community
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: MoJee., Pk"�n, d (A`w ` Business Name: Ra IQ
Address ,3 L' 6 2 4, ; Au City , i4 �y State Zip L-?Yy
Cell Phone: (au$) 31 7 0.P ( Business Phone: ( b-) 7c/ $ — 7 U 7 /
Fax: ( ) `7Li5 `7,321 Email y+wt ala,h SA •C.tj Ut
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
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
�Q — Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace lectric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & ADDlication
Point of Delivery must be shown on Dlans.
Si ature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho