HomeMy WebLinkAboutAPPLICATIONS - 08-00281 - 1676 Clements Ln - Mechanical06/12/2008 10:36 2086243774
HOUSLEY PUMPS INC PAGE 03
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CITY OF REXBURG
WCHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID, 83440
208 -359 -3020 X326
PARCEL NUMBER: O L (�Ve -- 0-
SUBDIVISION: UNIT+. _BLOCIK #
(Addrosing is band on the information - must be soaurats)
LOT#
PROPERTY ADDRESS: /fplb C� ►ne
PHONE #: Home ( ) _ Work
CONTACT PHONE
� P 11i % h t3 S
V Cell ( ) - 45 a 3 /
OWNER MAILING ADDRESS: CITY : e TE. LZIP: 8isly
EMAIL FAX
APPS (If other than owner)
(Applic:aat if othar than owner, a statement
to a6l A spent tr owner must seeciarmy
APPLICANT INFORMATION: ADDRESS (.t'.1e,sf rnQ' CITY:
EMAIL� - FAX oar/- 7 7
PHONE #: Home ( ) Work ( ) t ay - 3 77 a Coll ( )
MIC,T_ -
MAILING ADDRESS :_ -U CITY STATE_MP
PHONE: Homc #_ ^ Work# Cella
EMAIL ,_ FAX —
How many buildings are located on this property?_
Did you recently purchase this prvpe y? No Yea (If yes give owner's natnc)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: _
(i.e., Sisal FoLmily Kwidaxa, Multi Fam.11y, A,pgttrrteats, Remodel, GaraF, Oon morcial, Addifts, ft-)
APPLICANT'S SIGNATURE. CERTIFICATION AND AUTHORIZATION: U=Wr va*►tr otra0ey l Mreby aftfy 1M I lwve
rad this appticwoo and state thu to iron was!snip is Gorreet and I mew to vW iz bmow erdddl miw baedW be #eno W tae <n tMwi*D bt a 8u Pids r j
end Zoning Coniatinwa or a* City C&m it for rho City of Rubwa shall a tnIWI oil oor*eos. A epee to apnply with all C1d egttleo = od 3me reeve raletia{ to the
subject mama of oix epplioation and humby eotbonaed MV"cntmv ss oltJ o City !o OW "on the abovd 0ndoeW p WWW at wWW= parks• NOrM TIN
tmadina aftal ewy rs vobc u pumrt on wproval issued undar the prmum of du 2003 bturmbMIJ Gds !e awe of My 11LIe NWMrtA or IeLttop N of fm is
d,c rppk ei4u or on the p loss on�dhich are pant or animal ome bared. Pantsil void if DcA IWW witlde 110 dqs, rtsssit void if wwk stops to ISO days.
( -e./ z4 / 0, '
DAIT
at�uaaaa w vwpvrinppu�aut . ._._......-
Do you pmfer to be coutaated by C E ro le one
wARlv1]YG — D MUST BE FWZ11 ON CONII'MUCTION SITrs'
Piss fees ere non and are paid is full at the tltnt Of eppl11000111 11060 0109 JOINT I HIS
City of Rexber ='a Asa aav* of the pled review fa dose not cosstiluk pia. approvtl
06/12/2008 10:36 2086243774
Mar. 2r, 2JU1 j.!)9FMI •
e
Building Safety Department
City of ao xbuM
19 E main lonedt , VXbbp.a0 PNo w 209.959 9020 d%
RAxbu* ro U"O www.rsxburo.e6v F= 20US9.3m
PAGE 02
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NAME
PROPERTY ADDRESS
SUBDIVISION
permit#
Requiredlll
HOUSLEY PUMPS INC
MECHANICAL
Mechanical Contractor's Name: Wi chaed ,;51t , BusinessNa=: G
Address. U W o &i irYl a idi _ City ' F'. $tale zQ. Zip &r�S
Cell Phone. (20 g) _2) 40 - Q 3 1 BusirAss Phow: Qdk)
Fax: (a0 f-) U a4 - 377 Email
Mechanical Esdmate S Family Only)
FIXTURES A APPLMNCES COUNT (Sbgle Fmily Dwefift only)
Furnace Exhaust or Vent Ducts
_ Furnweo Air Conditioner Combo Dryer Vents
Heat Ymp
Air Conditioner
Evaporative Cooler
Unit Heater
Space Hcaw
_ Decorative gas -Bled appliance
Incinerator System
Boiler
Rangc Flood Vents
Cook Stove Vents
Bath Fan Vents
other sin ilar vents A ducts:
Pool Heater
_ Fuel Gas Pipe Outlets inclt4ng in or future outlets
Heat (Circle a]1 that sppty Oil Coal Fireplace Electric Hydronu
�i 1�1 ii 1 1� �uLl�! �/ r1�
81 pature
The
T License numbor
if the
tAw sane of Idaho