HomeMy WebLinkAboutAPPLICATION - 08-00179 - 3091 N 500 E - MechanicalCITY OF REXBURG • 1 0
MECHANICAL PERMIT APPLICATION Please cc 0800179
19 E
208-359- 020 X3 B URG, ID. 83440 If the questic 3091 N 500 E- Dalling
PARCEL NUMBE (We wni proviae mis for your
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS: 6&V r_
PHONE #: Home ( ) Work ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
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
STATE; ZIP
PHONE #: Home (
CITY:
EMAIL
Work (
Cell (
CONTRACTOR
MAILING ADDRESS: - ? -3 A S PLC i J CITY E-� 6v STATE J0 __ZIP 23
PHONE: H Home# -3S I 0 b . Work# 3 13 —o � 6 Cell# 7 I � -ajob
EMAI LS { �f W 4 ' R 0 0 - 1
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 split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., 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 1 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 revo a permit on prey issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or on th which Fe pe it or approval was based. Permit void if not started within 180 days. Permit void if work st ops for 180 days.
l 15 / b
Signature of Owie*/Alfplicant 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
FAX
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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C I T Y O F
REXBURG
Americas Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Dryer Vents
Required!!!
MECHANICAL
Mechanical Contractor's Name: 41— - t1►-- Business Name: X �z f3 -
Address �� �k:�, f.ti City ���� State (b Zip
Cell Phone: 0q) � 'l (� Business Phone: ( ) �3 S
Fax: 9 C4d-j Email JIS *,c4�1. YU, hoA �o
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelli Only)
Furnace / Exhaust or Vent Ducts
I Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
other similar vents & ducts:
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) as Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
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of Licensed Contractor
The City of Rexh
Permit#
Range Hood Vents
Cook Stove Vents
1 Bath Fan Vents
K
License number
it fee schedule is the same as
the State of Idaho
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