HomeMy WebLinkAboutAPPLICATIONS - 08-00312 - Hibbard LDS Church - MechanicalCITY OF REXBURG 0
MECHANICAL PERMIT APPLICATION Please c 08 00312
19 E MAIN, REXBURG, ID. 83440 If the quest
208- 359 -3020 X326 Hibbard Church -Air Conditioning
PARCEL NUMBER: W
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
4-DS
CONTACT PHONE #
PROPERTY ADDRESS: `7 39 K� 3 (,D
PHONE #: Home (
OWNER MAILING ADDRESS:
EMAIL
Work ( ) 3,S`i o lo36 Cell( )
FAX
CITY:
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.)
APPLICANT INFORMATION: ADDRESS
CITY:
STATE; ZIP EMAIL
PHONE #: Home (
Work ( )
FAX
Cell ( )
CONTRACTOR
MAILING ADDRESS: P(S - Lzsx , 1'�t CITY - 4 5ti W-L& Y STAT ZIP ° 3�7 ( I
PHONE: Home#
EMAIL
Work Cell#
FAX 3 ?- 3 4 1 �7
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjur 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 application and hereby authorized representatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building official may revoke a permit on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or on the plans on which theyehmyor approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
i � ��� �✓ / / !� 6
Signature of Owner /Appli a 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 FyoF�kXB�R�,d CIT OF
City of Rexburg � rVnT mG
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19 E Main ionellh @rexburg.org Phone: 208.359.3020 x326 America's Fatuity Community
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
NAME D S
PROPERTY ADDRESS oR66 - ) h(6f,1+A 6 b 6 Wlu ST Permit#
SUBDIVISION
Required!!! MECHANICAL
C6 M M G-#
Mechanical Contractor's Name: (fr Elm t t_'� Business Name:
Address ` in—bn I'�I City State Zip s3�2 7 y
Cell Phone: ( )
Business Phone: (969) 7 - ,:;13 �/ - )
Fax: ) -c3 3 4 Email C-f yl we�iZ�� f� , ►t,,��
Mechanical Estimate $ cR;� I 73� (Commercial/Multi Family Only)
r
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
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
y Signature of 6censed Contractor
The City of Rexburg 's
License number
schedule is the same as
-1-68
Date
the State of Idaho