HomeMy WebLinkAboutAPPLICATIONS - 08-00098 - 1954 W 3000 S - Mechanicalf eb. 21. 2008 3; 39PM •
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CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please ce
19 E MAIN, REXBURG, ID. 83440 If the questio
208 - 359 -3020 X326
. No. 59133 P. 1
is iii•:
1954 W 3000 S- Kennedy
PARCEL NUMBER: ��K ' j) [ 1 &3 (We will provide this for you)
SUBDIVISION: UNIT# BLOCK#
(Addressing is based on the information - must be accurate)
LOT#
OWNER: CONTACT PHONE # kQ Ahxe -CIOI
PROPERTY ADDRESS: / g S LtJ • c3 d�� s . �P.N GG�
PHONE #: Home 1 ork ( )
)
OWNER MAILING ADDRESS: j 6 AM 5 CITY: 2,zLc STATE�--,) ZIP:
EMAIL FAX
APPLICANT
(If other than owner) ZZ af,f y Q,r� Y z
(Applicant if offer d= owner, a statement authorizi�ag app *sat ant to act as agent: for owner most =company this application
APPLICANT INFORMATION: ADDRESS /�o�S �� CITY: =�!
STATE; ZIP EMAIL FAX A09' 5-o IW 411
PHONE #: Home ( ) Work &ell M.5,29 - 20 71
MAILING ADDRESS: 1,5V5 04e"ApooP_ CITY JA" STATE - > ZIP K3 d o
PHONE Home Work# .S.Z9 Cell# ,J o?D " 70 7 1
EMAIL FAX , 50?I &Fq
How many buildings are located on this property?
Did you recently purchase this proper - A�oes (If yes give owner's name)
Is this a lot sp ' O S (Please bring copy of new legal description of property)
Single Family Reside*, Multi Family, Apaafinents, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty o f poinry, I kntry certify that I have
road this application and statc drat the kfinnation hacin is wnad and I swean the cony infarmation which may haearm be given by mein hcwim8.r bcforc the Planning
and Zoni og Commission or the City Conseil for the tiry of ltexhurg shell be uudrHtl and correct I agree to comply with all City regulations and Stele laws relating to the
subject matter of this application and hereby authorized representatives of the City to ewer upon the above -m oned property for inspections purposes. NOTE: The
building official m oke a it on approval issued under the provisions of the 2003 International Coda in cases of any false stnument or misrapnesentazion of fast it
th p � the perm bwca Permit void if rot dart within 180 days, Permit void if wQ* stops for 1 SO days.
DATE
Do , er o e 00111 atrted by fax, email or phone? Circle One
WA)ltNMG — OUXLDXNG PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non- refundable and are paid In fall at the time of application beginning Ianwary 1. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
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Feb-27. 2008 3:39PM 0
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Building Safety Department
City of Rexburg
19EMoin pnetlh®rexburp.org Phone . 208.3593020x326
Rexburg. ID 83440 www.rexburg.org Fax: 208.359.3024
CITY OF
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NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required!!! M CHANICAL
//�� °�j �
Mechanical Contractor's Name: l'OY�� GC5rI Business Name: i� -
Address «�2,5 CA*WW%e- City - > 7� �.S State Z7> Zip
Cell Phone: (;&p 70 ,�� Business Phone: Pot)
Fax:
Mechanical Estimate $ (ComawerciaVMulti Family Only)
FUTURES A APPLUNCES COUNT (Single Family Dwe h Only)
�- Furnace _Exhaust or Vent Ducts
(, Furnace /Air Conditioner Combo ��2. ~ Dryer Vents
Heat Pump
Air Conditioner
7 Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Range Hood Vents
Cook Stove Vents
_ Bath Fan Vents
other similar vents & ducts:
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all tha Gas' Coal Fireplace Electric Hydronic
Point of Delivery must be shown on Mans.
lure ieeesed Cm ' dor Iacens number Date
The City of Rerburg's permit fee schedule is the some as required by the State of Idaho I
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