HomeMy WebLinkAboutAPPLICATIONS - 08-00300 - 1161 East Butte Rd - MechanicalJun 06 08 07:40a (208) 524 -0801 p,2
' _ 2 9 "V
9
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208- 359 -3020 X326
L
PERMIT #
Please complete the entire Application!
If the question does not appIY fH in NA for non applie* bte
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: U #__BLS# LOT#
(Addressing is based on the information - must be acetuate)
CONTACT PHONE#
PROPERTY ADDRESS:
PHONE #: Home ( ) Work {
OWNER MAI wci ADDRESS:
EMAIL FAX
A.PPLICAN T (If otl3er then owner)
(APPUcm if other than bwncr, a stm ment autl)orizing aPPficatrL to sct es agerst for awt3cr must this
accongxMy applicaior.)
APPLICANT 1NFORMATIOW ADDRESS
STATE
PHONE #: Home
CITY;
. ZIP EMAII. FAX
Work ( ) Cell(. )
MAILING ADDRESS. l' �i� L . Sao CITY STATE . ZIP 1,440
PHONE: Home# 356 GyeQ Work# Cell# D - 'Dai l
EMAIL ___FAX 5511
How many buildings are located on this property'? - - —
Did you recently pwchaft this p No Yes (If yes give owntr's nemc�
Is this a lot split? NO YES (Please bring copy ofnew legal description of property)
PROPOSED USE:
(i.e., Singh Fm nity Re
..MUU raumY A P='ZDC=% Reattodol, Gwfte, C4D= Mi4 A M ion. Etc.)
APPLICANT'S S1G1,1 ATLSRi�, C ERTIFICATION AND Aini4ORIZATION U„e� � y " i �, ^ ,. ; ,,�,�I h
read this +eQphpttiov and sale fl+� itefe►mstiee bosin is ooa'oot sad 1 swcw &a "W iat'etraaden wbicb My bcreaftv be giwa by arc w
aid zonbg Commimiem or the�iiyr Cottta fbc the CRY of Rexbwg shall be teuthfal asd correct. f apex to comply with ag C3 W the Flaes�iee
subj� mouser of $� appiicatieie and bsreby swhoriad erpewntaares of the Clay to ete0es upon t}u nDow- ona►iioird propsrry b oes �� l"s relafte to Elie
bedJdirr a�fdab nary rcwko a z en v ismred aada the prevision of tiw 2M boom Cc& in caw of soyta "mrmmImt or D7ftecpreamNaum of rid to
the spplieatfen or on ft phms Vtieieb the pcmft a approval eras baled. N=il word *f" rvitbnn 1 to d*x Permit Void if walk stops for lac A03,
Signature of OwnedAPP44mt !
Do you lxofw to be gb DATE
vSr f ax, tatma�l or phone? Circle Que
WARN Wr_ _ `RLgi.DlNr PERMIT MUST RE POSTED ON CpA1SMUCTtON S)TE!
ees
Plan f are aott- raftWoble and are paid In f it at the do" of appllewtles begJanivg jam,"" y.Im-t
City of lte mbarg's Aeoeptaaee of tbw plan review fee does not coasbitate pla ■ apprws l
Cell (
CITY; STATE: ZIP:
06 08 07;39a
-c ,. L 0,
(208) 524 -0801 p.1
�vJl'
Building Safety Department
Ch of Rexburg
19 F Mcin lanellho, exburg, org Phone: 208.359 3020 x326
Rexburg, iQ 83440 www.reXburg,or9 Fox: 206,359.3024
NAME 1
PROPERTY AI
SUBDIVISION
i CITY O F
REXBURG
u
Amok4F4mvffyC MMUglry
R- eYhH, JW. Permit,
4u.i a% (A-
fk�tk" nA- 4
Re quiredh f ! MECHANICAL
M=hanical Contracjtor's Name: 44 It- 4 "t rs4>v`.
Business Name: 13 s
Address 155 5 u� . � . w s ► r tj. City r1 EloL , 446 State 2,A Zip
Coll Phone; ( ) � S$I - el I s7 Business Phone:
( ) _S 4 - 1737
Fax:( ) _ �a4 - 080 Email t> I 6o
Mechanical Estim*te •S � (CommerciaUMniti Family only)
FIXTURES & APPLIANCES COUNT (Single Fancily Dwelling OrrJy)
macs Exhaust or Vent Ducts
al - FurnacclA;r Conditioncr Combo ___ — Dryer - Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler _- 5 - Bath Fan Vents
Unit Reatef
Space Header
Decorative, gas -fired appliance
IncineraSorSystem
Boiler
other similar vents & ducts:
11 �
1 Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) 6i* Coal Fireplace - Elect- -de _ Hydronic
I Point Of M05n y must be shown ou DIRR
signstrue of Lideased Contractor
Luense Dumber new
schedule rs the some ar repaired by 1he ojldeho