HomeMy WebLinkAboutAPPLICATION - 08-00237 - 1887 W 7800 S - Mechanicalw � •
CITY OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION Please c 0800237
19 E MAIN, REXBURG, ID. 83440 If the quest
208 - 359 -3020 X326 2 1 887 W 7800 S-O
PARCEL NUMBER: P\, 6 ,, r � '3CJt _5(0�j 5 . PW
SUBDIVISION: UNTO l rr
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS:
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
CITY:
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 ( )
Work ( ) Cell ( )
CONTRACTOR
MAILING ADDRESS:
PHONE: Home# _a:g;__ Workh
EMAIL FAX
- CITY
STATE AO ZIP
-� Cell# a3/7—
Did you recently purchase this property? No es (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
ZIP EMAIL
FAX
CONTACT PHONE #
-��v S
Work ( )
STATE: ZIP:
CITY:
FAX
(i.e.,/Single Family Reside 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 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 r 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 at lication and here orized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building official mly r voke a permit on al issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or o e pl s o which it or approval was based. Permit void if not started within 180 days. Permit void if work stops fo 180 days.
Signature of O ner pplicant 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
Cell ( )
Building Safety Department
City of Rexburg
19 E Main i.anellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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CITY OF
REXBURG
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America§ Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MEC NICAL
Mechanical Contractor's Name: Business Name: �J ��
Address �17 W �(� City State Zip y ��
Cell Phone: Business Phone:
Fax
Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES 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
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Boiler
Pool Heater
Fuel Gas Pipe Outle uding stubbed in or future outlets
H a Circle all that appl �asil Coal Fireplace Electric Hydronic
Point of Delivery must be shown on plans.
Contractor License number e
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho