HomeMy WebLinkAboutAPPLICATION - 08-00126 - Paul Weeks - MechanicalCITY OF REXBURG •
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
PARCEL NUMBER:
_( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE # 3s� - S 2,1
PROPERTY ADDRESS: a0 00 W .
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: Sc_� CITY: 44qg STATE:TLZIP:
EMAIL FAX
APPLICANT (If other than owne I,J, -ON k "� �„ ,,, 6, � 't
(Applicant if other than owner, a statement autliorizing applicant to act as agent for owner must accompany this app cati,
APPLICANT INFORMATION: ADDRESS 51 P7 W, SaiaO Al . CITY: a/ V&49 y
STATE; _J ZIP 6 34 4-e) EMAIL &1'11 7d r dQ ,n FAX 4� '
PHONE #: Home (te8) 35q - 11¢Q7 Work (76p,) 313 - 33 06 Cell 06) ,3/3 - 339
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell# 313 _ 3 3 ° y
EMAIL FAX
How many buildings are located on this propertv?
Did you recently piy4base this property?
►-[ O
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Ap
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 the 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 authorized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building official may revoke a permit on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application Qn th / � pl which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
. __
r (/ 0.3 / / 6 / 68
Si tune of Owner /Applicant DATE
Do you prefer to be contacted by fax, email or phone? 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
PERMIT #
9
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
No Yes (If yes give owner's name)
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
NAME W ' ( I
PROPERTY ADDRESS 29
SUBDIVISION
01 %tXB V*
U �
CITY O F
REXBU
.._____ CW _
Americas Family Community
N too Cj ,
Permit#
Required!!! MEC�NICAL
Mechanical Contractor's Name: n- Gl k P /14
Busifiess Name:
Address t,) - 5 c0 e) ` City '12t)cb �4tecti State 74 Zip 19 3I
Cell Phone: (20g) 3 ( 3 3 .-�7 G Business Phone: (Ze) 3 5 -- 67jo — 7
Fax: (zoo) - f ( ?4 - 6 q Q Email Kw 1 [ 7(�5 /' c4
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Mechanical Estimate $ (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 Heater
[ Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
3 Fuel Gas Pipe Outlets including stubbed in or future outlets
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
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. ;�, &,k
Signature of Licensed Contractor
The
C1367
License number
schedule is the same as
the State of Idaho
0 3 V/0,9
Date
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