HomeMy WebLinkAboutAPPLICATIONS - 08-00257 - 1956 W 3000 N - Mechanical06/02/2008 12:26 2086243774
IV I
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please
19 E MAIN, REXAURG, ID. 83440 U the 41M
208 - 359 -3020 X326
HOUSLEY PUMPS INC PAGE 02
0800257
1956 W 3000 N- Mackay
PARCEL NUMBER ; y:WLR�� F Q(t Q _( Nye will ptovlde this for you)
SUBDIVISION: UNIT# BLOCKS LOT#
(Addressing is based on the information - must be accurate)
Y�& 1Y►e 1� p.�� : o iy�,�k �� CONTACT PHONE 0 q -?
PROPERTY ADDRESS: _ 09 U 'LO • ? 6LI 0 A/.
PHONE #: Homo (�� = s Work ( ) Cell ( )
OWNER MAILING ADDRESS: ( J s W Ad /V. CITY: a k _STATE ZIP:_
EMAIL FAX
, (if ocher than owner) { �m�sl • �u. 7a;zca
(Applicant If other than owner, a statement authorizing a !cent to uf as agent for owner most awompany this application_)
APPLICANT INFORMATION: ADDRESS VO r' Jts ftL&'kt CITY: Sk
STATE;� ZIPS EMAIL_ _ FAX / 377Y
PHONE #: Home ( ) Work aq 37 zh cell )
CONTRaGTok --+Ea z _� J� ij w►.,..,a
MAILING ADDRESS: —U C ITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How manv buildings are Imitthd on this rannerty?
Did you recently purchase this pmparty? No Yes (If yea give owner's nafne) __
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(LO., %46 Favily Residence, Multi Fatn.ily, Apartments, P- Modal, Garage, Comsmerclal, Addition, Etc.)
APPLI CANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: vn& patsld Ofpapury, 111000 carufy We I sew
teed this ePI Ilc+4>oa and s one that rise roll m Woe amda Is comet sod 1 swar tml any latbsreuiaa whlah my hareOm bo *m by toe b bsrrinp belbre tae Ptaonisa
and Zooft Coanaiiu as of tM City Colasoll ft the City of Rarbot; lb&D be im6bl and 0otreol. I yne to ownply with All OW ssgtlmieae.a 4 8nu laws misting to htte
subject mam of this opliaston mad bctr by ardborivW foprofet gvw of the City to sew upon tale abouaa mwimsd p vp" for mspeatiattt pwparot. NOTE Tba
building oftisd may rowlx u pennit on y rvvs1 issued widet tae ismiskm of the 2003 loretasumal Code In was or MY *bb s or PRIM teseot�ia n of bet io
Ow Tplic'06 OT or W plans a, q VWA t pstsait of approval was based. rertah void if not Men! wi" ISO drys. Ibmsit void If wait Reps for 180 deys-
of OwnvrrApplic t DATE
Do you prefer to be contacted y fix, email CIMIC One
WARN ENO — evu t,�w C ale; POSTaJO or! CONSTRUCTION SITE!
Plan fees are son- refoodable mud are paid in full at the tiase of application befloalse q b ary 4 M
City of Raltborg's Aweptaoce of Via plea review fag does not coast Me plan approval
06/02/2008 12:26 2086243774
Mar. 21, 2,1u/ j; J9rM
PAGE 03
N3. 333? P. 3
HOUSLEY PUMPS INC
Fulldino Safety Department
City of Roxbury
19 E MC10% 1*r&ffiWrffxbV.&V Phens: 20&339.3020 X=
R ezbwg 0 ""a wwwexbouow F= 20L359=4
CITY of
REXBURG
NAME
PROPERTY ADDRESS
SUBDIVISION
permit#
RequiredIll
MECHANICAL
` �R',AfjgdL B Now: /11,1 C 1� ),
Mechanical Contractor's Nwnc.- —
u
Address 40 citv. l A. Stale _Tk1
Cell Phone- (Po k) 32 0 - t� :5/ — Busims Phone: (aa)
Fax: (d-N 1 '14 Email
Mechanical Estimate S (Commsreial/Muld F&mW Ouly)
FIXTURES & APPLLAINCES COUNT (Single Fwxdy Dwflbl 0*)
Furnace Exhaust or Vent Ducts
Fumuc/Air Conditioner Combo
Heat P=p
Air Conditioner
EvaNzative Cooler
Unit Heater
Space Heater
Decorative ps-fired appliance
Incinerator System
Boiler
other siniflar vauts & ducts:
Pool Heater
Q Fuel Gas Pipe Oudds inclining stubbed in of filmm outlets
Heat (Circle all that apply) a Oil Coal Fircpi= Electric Hydrogo
M. rj; 1
Ml - MJ 7..TW=
Dryw vents
Range Hood Vents
Cook Stove VMb
Bob Fan Vents
The OLO xat3 i teich"Wo ti the �Suwf 0