HomeMy WebLinkAboutAPPLICATION - 08-00034 - Archer/Lyman Elementary School - Mechanical0 0
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION 'lee 0800034
19 E MAIN, REXBURG, ID. 83440 If the tltte Archer Lyman Elementary School
208 -3,59 -3020 X326
PARCEL NUMBER: V905 0 35 E % � W ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
0 WYER:Gf-,C)f- f'p'YJYYI6 _ i 1 CONTACT PHONE # 2
PROPERTY ADDRESS:
PHONE #: Home (
Work (
Cell (
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,.L1 vv .yLL,RL 6
�S� � �. -- j CITY:� TfiiE: �GIP�
EMAIL FAX
APPI_IC'A1VT (If other than owner) �fC�:YII CQ
(Applicant il' other than owner, a statement authorizing applicant to act as went for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY: Y�
STATE: ZIP EMAIL Y me _ AX
n
PHONE #: Home ( )_ _ Work (�j) 5ks3- (,o21o� Cell ( )_
CONTRACTOR C)Hcurn r- - 06�5-t -(U `�'�
MAILING ADDRESS: 1 911 �. x)Q t� el Y �JJ71 nV� tQSTATE �� ZIP _ -
PHONE: Home# Work # CJ I " 11 &D" Cell #�
EMAIL FAX
How many buildings are located on this property`?
Did you recentiy purchase this property `% No Yes (If yes give owner's name)
Is this a lot split? O YES (Please bring copy of new legal description of property)
PROPOSED USE: CO*YY) (ne -YC,a\
(J.c_ Singlc Family Residence, Multi Fancily, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: t - finder penalty oi I
read this application and state that the information herein is correct and I swear that any inFormation which may herealter he Liven by me in hearings h�:Iolc thr I'Iannin,
amyl 7onin�_ Co umissiou or the City Council tit the City or Rexhuro shall he uuthrnl and con I Lan to comply \\ ith all City regul:n10n,1 and Stair
aihjcct mater ol'this application and hereby authorized representatives of the City to enter upon the above- inentionud proputy tit imspections purposes. NOTL Ilic
builJin _, oIIicial ntay rceoke a permit on approval issued under the provisions of the 2003 International Code in cases of any lake.;tatemcm ot 'd
the :ippliculloll or, he pla�if it or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
*nature ol'Owner /Applicant DATE
1 [t3 hc.. i2(lnLl tcd I1} ax. i2mai1 or [bode' Circle 011C
WARNING — BUILDING PERMIT MUST BE POs "rED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in Will at the time of application beginning Januai , !, 2005.
City of Reaburg's Acceptance of the plan review fee does not constitute plan approval
Jan, 4, 2008 12:58PM
` • i
Building Safety Department
City of Rexburg
19 E Moin jonellh ®texburg.org Phone. 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
No. 5595 P. 3
�d
C I T Y O F
REX
Ameriwd Family Community
NAME FC QVI
PROPERTY AI
SUBDIVISION
Required!!!
MECHANICAL
Mechanical Contractor's Name: 7 i_"\ MPC `3Q n ' l C C4 Business Name:
Address City State U zip3
Cell Phone: ( ) Business Phone: ( 26? ( a ?_ (.p
Fax: (`� ) J `"�/ Imo _ Email +�j ra • Vt oL )ardor i rylM-tca -► • c o
Mechanical Estimate S y 13 L 950 C() (CommercialiMulti Family Only)
FIXTURES & APPLL4NCES 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:
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
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Signature of Licensed Contractor License number
The City of Rexburg's permit fee schedule is the same as
Date
the State of Idaho