HomeMy WebLinkAboutAPPLICATIONS - 08-00014 - 2244 Diamond H Lane - Mechanical0
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please c 08000
19 E MAIN, REXBURG, ID. 83440 If the quest
208 -359 -3020 X326 2244 Diamond H Lane -Lewis
PARCEL NUMBER: We win provicle this for you)
SUBDIVISION: -� ` UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER:CClTT CONTACT PHONE
PROPERTY ADDRESS: 'Z Z qY .Dl A�.oNI) )4 Z- Ac.I e
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
FAX
CITY:
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; ZIP EMAIL
PHONE #: Home ( )
Work ( ) 33'( - 53i Cell (3*1) 36'1 - 9913
Work ( )
Cell ( )
E ESS: CITY STATE ZIP
Work# Cell#
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 USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
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
anyapplici6n mission 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
su this application and ereby authorized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
b ay revoke ape n approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
th on the plan s on 1 h the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signa ure of diiner /Applicant DATE
STATE: ZIP:
CITY:
FAX
Do you prefer to bi l 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
19 E Main janellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
OF REXB U'PC
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CITY O F
REXBURG
America§ Family Community
NAME 5t vT7 I e... i 5
PROPERTY ADDRESS 2-?_
SUBDIVISION SACJU l e o t'ee
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: Business Name: - c ti `x C4- .n 11C
Address &II& ci ecl e City k X67 State 3>A- Ho Zip €33`1
Cell Phone: ( Zoe >) 9 v - o 5 z�5_
Business Phone: ( )
Fax: ( 't') Email � can Ase , -.f i et-i,S C_ � ca
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
I- Dryer Vents
Range Hood Vents
Cook Stove Vents
�_ Bath Fan Vents
other similar vents :its:
Pool Heater
L Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) (9 )"1 Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
n Point of Delivery must be shown on plans.
4 13 z:1 I 0 8
Signature o v icensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho