HomeMy WebLinkAboutAPPLICATION - 08-00167 - 4019 Molly Dr - MechanicalCITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the ques 0800167
208 - 359 -3020 X326 J 19 Moll Dr -Evans
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PARCEL NUMBER: [ I ( V Y
SUBDIVISION: UNIT# BLOCK# L04# It
(Addressing is based on the information - must be accurate)
OWNER: /c/< Atr CONTACT PHONE
PROPERTY ADDRESS: 40 ;'D /7 &
PHONE #: Home (208 357 AIVY Work 008) 35.9 &1Y1 Cell 1ZfY
OWNER MAILING ADDRESS: 6"7 Gt/r uw,o04 CITY- �y , - STATE�ZIP
EMAIL •PDE�/.�,v s Q �!/.w.s.VAties�o-cotGC� GoN/�
APPLICANT (If other than owner) OUTA/`
(Applicant if other than owner, a statement authorizing applicant to act
APPLICANT INFORMATION: ADDRESS
STA
PHONE #: Home (
Work (
Cell (
CONTRACTOR i / ybc f C- WrINt�'
MAILING ADDRESS: —2 Y - '5 - 3 Lo y00 N
PHONE: Home#
EMAIL
FAX
_CITY STATE & &4 ZIP ?3�/z/�
Cell# 370 -
How many buildings are located on this property? QN.�
Did you recently purchase this property? No elf yes give owner's name)
Is this a lot split? Q S (Please bring copy of new legal description of property)
PROPOSED USE: � Jgsxozove_�
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjury 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 lication and hereb authorized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building officia evoke it proval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the applicati n p s ch the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner /Applicant DATE
Do you prefer to be contacted by fax, email phone Circle One
WARNING — BUILDING P MUST BE POSTED ON CONSTRUCTION SITE!
for owner must accompany this application.)
CITY:
ZIP EMAIL
Work #e c I/• -/ �,�
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
Building Safety Department o 40.�Xg�Rr,,
C I T'Y O F
City of Rexburg n rVT�T mG
� 0 1�.IP.11.17 V 1\
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19 E Main janellhQrexburg.org Phone: 208.359.3020 x326 America's Family Community Rexburg, ID 83440 www.rexburg.org Fax. 208.359.3024 ° " °'
NAME
PROPERTY ADDRESS / Permit#
SUBDIVISION , f
Required!!! MECHANICAL
Mechanical Contractor's Name: f7, �) Business Name:
Address Al City State Zip X35 Y
Cell Phone: (tog) 5ZO •-- ",3 Business Phone: 4.2
Fax: (-*?- ) X2,1 — -722.
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo 2- Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets 1AY2 p ,8 y OZ �
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Email
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & ADDlication
Point of Delivery must be shown on plans.
Signature of Lic nsed Contractor
/t/11
License number
2 r (Je
Date
The City of Rexburg's
schedule is the same as
by the State of Idaho