HomeMy WebLinkAboutAPPLICATION - 08-00180 - 546 Park St - Mechanical. r 0 0
CITY OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
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)
CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home Work ( ) Cell ( )
OWNER MAILING ADDRESS:
EMAIL
CITY:
STATE: ZIP:
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
PHONE #: Home ( )
ZIP EMAIL
Work ( )
Cell#
CONTRACTOR
MAILING ADDRESS:
PHONE: Home#
EMAIL
FAX
Cell ( )
STATE ZIP
How many buildings are located on this pro y?
Did you recently pAwchqse this prope t Yes (If yes give owner's name)
Is this a lot spli' . NO YES (Plea ri ng copy of new legal description of property)
PROPOSED U
CITY:
FAX
CITY
Work#
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under penalty of perjury, I hereby certify that I have
read this application ' d state that the info i herein is correct and I swear that any information which may hereafter be given by me in hearings before the Planning
and Zoning Com is on or the City Coun I
o 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 i application and here a rized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building offibial revoke a permit on pr issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or the plAslop�hich th a oj aAproval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
A"NP V F V / /5
Signature of O ner/ plicant DATE
Do you pref r to be contacted by 'I email or phone? Circle One
WARNING — LDING 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
Building Safety Department
City of Rexburg
19 E Main /aneiih@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org _ -" " --
NAME
PROPERT ADDRESS
SUBDIVISION
y t� CITY OF
n 7
° REXBURG
._ 11
Americas Family Community
0000100
546 Park St- Hilton
Required!!! MEC NI C;AL
Mechanical C ntractor's Name: Business Name:
Address ity State zip,d�
Cell Phone: (A9& �/Z- y�7e� Business Phone:,Va)
Fax: ( ) Email
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
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply Gas Oil Coal Fireplace Electric Hydronic
Me anical SiAniz Calculations must be submitted with Plans & A
t
I — P oint of Delivery must be shown on plans.
flaw //W Z/'-/S rtl'&
Si t e of Lic sed Co actor t I License number Date
ication
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho