HomeMy WebLinkAboutAPPLICATION - 08-00110 - 2614 S 1400 W - MechanicalCITY OF REXBURG
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MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
PERMIT #
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If the question 1
PARCEL NUMBER 6M f (We wi
SUBDIVISION: UNIT #_
(Addressing is based on the information - must be accurate)
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2614 S 1400 W- Erikson
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OWNER: — Y/ — ^ CONTACT PHONE # -31 - 7 l
PROPERTY ADDRESS: ,�✓ 1�� ��
PHONE #: Home ( ) J � y �j— �G'��� Work ( ) Cell(
OWNER MAILING ADDRES 466 Gtr O. '9- CITY: STATE, ZIP: c95 J
EMAIL FAX
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 CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR & 7^ 43
MAILING ADDRESS: ? CITY STATE/ ZIP X 9 0
PHONE: Home# , Work# 2 "Cell# /fir
EMAIL ��h��_fi�i /�� 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 splittj (Please bring copy of new legal description of property)
Single Family Residence; Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalt of perjur 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
and Zoning Commission or the City Council for e City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the
subject matter of this application and hereby a orized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building official may revoke a permit nap oval issued under the v ns of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or on the plans on whi h e permit or approval Permit void if not started within 180 days. Permit void if work stops for 180 days.
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Signature of Owner /Appli t `If
Do you prefer to be contacted by fax, email or one? 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
I- . 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
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CITY o F
REXBURG
America's Family Community
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PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MECHANICA4
Mechanical Contractor's Name: q ,j wzv 4" Busin c5 ! ` esFte:
Address 46IX ee� City State Zip �f
Cell Phone: (
Fax: (
Business Phone:
Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace 5 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
other similar vents & ducts:
/ �_2 Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Ga it Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on Dlans.
ignature of License , orcontractor License number UU Date
Dryer Vents
Range Hood Vents
Cook Stove Vents
-- Bath Fan Vents
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho