HomeMy WebLinkAboutAPPLICATIONS - 08-00255 - 301 Pollard - Mechanical0 •
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Pleas 08 00255 l r
19 E MAIN, REXBURG, ID. 83440 If the q 301 Pollard - Loveland le
208 - 359 -3020 X326
PARCEL NUMBER: LE k ..„ W��� piLuvLuc Lins for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
0RWER: CONT CT PHONE #_
PROPERTY ADDRESS:
PHONE #: Home ( ) - 5 Work ( ) Cell
OWNER MAILING ADDRESS: CITY:
EMAIL FAX
STATE: ZIP:
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
CONTRACTOR
MAILING ADDRESS: MAI CITY STATE/ZIP
PHONE: Home# 3:5 Work # ` ,'��-� Cell#
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this propert Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of p )
PRO �g — le S /�
(i.e., Family mily, Apartments, Remodel, Garage, Commercial, Add io t . l
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 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 appli tion and hereby authorized r presentatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building official m re e a permit on app iss under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application ch i a proval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
/5;" - l
Signature of Own /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
Building Safety Department
City of Rexburg
19 E Main ionellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
O � QBX 8 Jt,*
's
U �
C I T Y OF
REXBURG
__ _11.11.1 CW __
America's Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! M_ ECH NICAL
Mechanical Contractor's Name: Business Name:
Address > >� j�� /�� City A / 4 / 9 State Zip
Cell Phone: ( ) �/ � W1 Business Phone:
Fax: ( ) C Email
Mechanical Estimate $ OM (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
D ecorative gas -fired appliance
Incinerator System hole+
Boiler
Pool Heater
�
Ct 'fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that appl Gas it Coal Fireplace Electric Hydronic
cal Sizing Calculations must be submitted with Plans & Application
Po int of Delivery must be shown on plans.
of ' ensed c6tractor License number Date
The City of Rexburg's permit fee sched is the same as
the State of Idaho