HomeMy WebLinkAboutAPPLICATIONS - 08-00079 - 4130 S 5500 W - MechanicalFEB- 20-2008 WED 11:36 AM FIRS CALL JEWEL FAX N0, 12085292793 P, O1
; FEB-2012008
15, 2005 2 :21PM No, v yiD r. L
3 o3 CITY OF RFYB UR G
nL+b71CTT eE
BUIMjNCr PERMIT APPLICATION Please 08 00079
19 E MAIN, RE )MUR0, ID, 83 440 If the que
203 -359- 3020 X32 4130 S 5500 W -Boice
PARCEL NUMBER _ 1 N F I (G
SUBDIVISION: UA.....
(Addressing is based on the information - must be accurate)
PROPERTY
PHONE #: Home ( � ,� - Work ( ) Cell ( � s O 7
OWNER MAIL ING ADDRESS: CITY; STATE: ZIP:
EMAIL FAX
v
AP�PLl, CANT (If other than owncr)
(Applicate if other than owner, a statement authorizing appllaam to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS C = S
STATE; ZIP EMAIL F_
PHONE 4: Home ( ) Work
r
PHONE: Home# Work# ell##
EMAIL FAX �� 9- � 7�3
many buildings are locamd ca this proptnT
Did you recently purcbme this properrP. No Yea (If yea give ow='s name)
Is this a lot split? NO YES (PIe»e b6n copy ofnew legal desmipdon ofpropaM)
PROPOSED USE: ,
(La-. Slagle Family Rmidenae, Mold Fantlly. ApUMMU, Remodel, Garage, C==Tc , Adds cm, Etc.)
AP'PLICANT'S SIGNATURE, CERTIFICATION AND A=0RIZATION: 17naarpaaalty of paprtty, I hereby ceeod3� tl a i
bwv and tbia applim= aad scare da the ittfotmsdcabmvio is oaetsat ant 1 aww that wy fi&geed1m which Qsy ltW2 t f he:iM by ore In haeMp betbte•ee
munbs sad zoattlO Catmniniao orate oily Coattail *r the City of Ra&n shall dm arrahad and coact I alem to eaaply wie a0 City re8alalom and sues laws
m4 ttale the rub jaot mutter of this spplicadw sad hereby vAcrod storreesttaterea orttu City to ems! upon at alwve -m a d paopw lbr tagoodm powm.
NOTE: The bidldiog a0'ioial mw ret+olre a pcsmit os eppevval iselrad sealer fete pnrvisiam odtter 2000 ltttrmaiaad Coda is spat of any false shsamagt or
mluupnnatatloa offmin to oonllglJan of on tbo D1®a on *bleb rho ponnit orgpvwl wn bored. Permit veld if oat started whbj4 180 &')'L ?remit void ifvA=k
atope lbr 180 dye. ,
Germane [)vn►er 4 ens DATB
Do you pnfarto bc aoutaoted by fan, emmil or phony? Circle One
WA>i raNGr— gCl>TMM laalln!'mmT lm PosT= Ob f cONm=crtarlff=I
PIRA *man non -ra hadt W6 and are pt W faftH at tbs an et; 9pp110 019 W5"@9 JfiM= - M
C1 ty a[R=berWs Accalt"a of the pim i njew fm dew not waste Phu appr"W
3
�� CONTACT PHONE # W-<-
FEB -20 -2008 WED 11:37 AM FIRS CALL JEWEL
M.15. 2005 2:22PM
Please complete the entire Application!
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
FAX N0. 12085292793
No. 0925 P. 3
If the question does not apply till in NA for non
permit#
P. 02
Required!!!
MECHANICAL
Y _
Mechanical Contractor's �N Business Name- I
Address Cit3' State /) ;Zi
Contact Phone: ( ) ? 7 7 Business Phone: ( )
Email Fax
Mechanical Estimate $____•__,� -__ (Commereial/Muld Family Only)
FIXTURES & APPLUNCES COUNT (Single Family DweMng Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaparwive Cooler
Unit Heater
Space Heater
Decorative gas -Fred appliance
Incinerator System
Boiler
Pool Heater
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Similar fixtures or Appliances
_ Fuel Gas Pipe Outlets including stabbed in or fat= outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Chas Oil Coal Fireplace Elcctric
!Mechanical Sizing Calculations must be submitted with Plans & Applic$tion
Point of Delivery most be shown on plans.
Sigaetnre of L ceneed Contmetart Ucwue number
Required!
7I1e City of Rax,6nwg's permit* schedule it the Same a
Ma
0-
the setae