HomeMy WebLinkAboutAPPLICATION - 07-00629 - 4012 Molly Dr - New SFR MechanicalDDec,27. 2007111:32AM
ITY OF RM BURG
Heaven s Best
•
MECHANICAL PERMIT APPLICATION Please c l 0700629
19 E MAIN, REXBURG, ID. 83440 If the questi
208 -359- 3020X326 4012 Molly Dr -Munns
PARCEL NUMBER: . (We
SUBDIVISION: UNIT# BLOCK# LOT#—E��
(Addressing is based on t e information - ust be acourate)
OWN ER - . CONTACT PHONE # L
PROPERTY ADDRESS:
PHONE #: Home ( ) - Work ( ) Cell
OWNER MAILING ADDRESS: � CITY; STATE- ZIP; ;C4L/6
I✓KU y�nn.� 12
d EZMCANT (If other than owner)
(Applioant if other thaLa owner, a statement
APPLICANT INFORMATION: ADDRESS
STATE
to act as agent for owner must accompany this application)
N 2963 p. P.. 1
CITY:
ZIP— EMAIL
PHONE #: Home ( ) Work ( ) cell( )
CONTRACTOR
MAILING ADDRESS: t
PHONE: Home#
CITY S TATE_IL) zIP
Work# Cell#
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property? No es (If yes give owners
Is this a lot split. NO YES (Please bring copy of new legal description of property)
PROPOSED USE: r m i I\vl t
(i.e., Single Family Residence, M amity, Apartments, Rem del, Garage,
Etc.)
APPLICANT'S SIGNATURE, CI31ZTIFICATION AND AUTHORIZATION: under penalty ofpcdury. I horcby certify that 1 have
read this application and state that the lolbimuion hm[A is correct and I swear that any information which may hanaftar bo given by me in hcatiop bcforo the Planting
and Zoning Commission or the City Council for the C1W of Rexburg shall be trulhfhl and correct_ 1 agree to comply with all CW regulations and Stoo laws rolating to the
subject matter of this application and hereby authorized representatives of the City to enter upon the ahove mendonod pmpanyy fiat lnspecdons purposes. NOTE_ The
building official may revoke a permit on approval I tswd under the provisions of the 2003 International Coda In cases of any false statement or misrepresentation of fact in
The ap lieatiom or on the lane on wbieb the Petro$ or approval was ba" Permit void if not started within 180 days. Pwinit void if work stops for 180 days.
J
Signature of er /A pffcant DATE
Do you prqcr to contacted by fax, email or Circle One
WARNING — 13UMDI NG PER MUST BE POSTED ON CONSTRXICTfON 9NTZI
Flan fees are non- reforkdable and are paid In fill at 11116 titre of application boglnning Ala= L aoo5.
City of Reliburg's Acceptance of ibe plan review fee does not couetltuto plan approval
FAX
DDec.27. 2007111:32AM Heaven Best
Building Safety Department
City of Rexburg
19 E Main f ane11h ®rexburg.org Phone: 200,359.3020 x326
Rexburg, ID e3440 www.rexburg.org fax: 208,339.3024
NAME
PROPERTY AI
SUBDIVISION
N,No_ 2963 p, P. _ 2
a ads Rs
CITY OF
REXBURG
cam,
' Arnerlra' Family Comgrumty
Required ►,►
MECHANICAL
Mechanical Contractor's Name-, Busin C� Name: c�A�.. G
Address City State Zip
Cell Phone: ( ) Business Phone:(
Fax: ( ) Email
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or Mture outlets
Heat (Circle all that, apply) 8 Oil Coal Fireplace Electric Rydronic
Mechanical Sizing Calculations must be - submitted with Plans & Application
� rw rrrna.rr.�r+�r� n
Point of Delivery mustbe shown on plans.
Signature of.Liceneed Contractor
The
License number Date
sched to the sam as required by the Stare