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NAME ! U
PROPERTY AD
SUBDIVISION
Dryer Vents
Range Hood Vents
Required'!!! MECHANICAL
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Mechanical Contractor's Name: I Q A Tj�,►_ j usines�s arne:
Address q �.� _ City State ZipL
Contact Phone: (Zoe) M ie L W I Business Phone: (?Vg) 315
Email ��Li �1 Fax
Mechanical Estimate S (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 Neater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
0800046
Holiday Theater
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
new
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
e o Licensed Contra for
The City ofRexburg's
11 9 3 i /
License number I Date
(ee s chedule is the sane as required by the State of Idaho
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