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HomeMy WebLinkAboutAPPLICATIONS - 08-00314 - 1075 N 12th W - New SFR MechanicalSep.10. 2067 11:29AM No.463E P. 2 CITY OF REXBURG PERMIT # MECHANICAL PERMIT APPLICATION Please complete the entire Application! 19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable 208- 359 -3020 X326 PARCEL NUMBER: ( We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) OWNER: CONTACT PHONE # PROPERTY ADDRESS: PHONE #: Harm ( ) Work ( ) Cell ( ) OWNER MAILING ADDRESS: EMAIL FAX CITY STATE; ZIP: APPLICANT (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner trust accompany this application.) APPLICANT INFORMATION: ADDRESS STATE; ZIP PHONE #: Home ( EMAIL Work ( CITY: Cell ( CONTRACT01 MAILING ADDRESS: 1agS 301:'7 ,c). CITY 11 g � STATE ZIP S3gw PHONE: Home# I S6 - 0 22. Work# Cell# 3!j U EMAIL FAX 3 S& - 9S/ l 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 brim 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. UXrdcr perwky of pegwy, t hereby certif that I have read this applicatiou and state that the kfoamation harsin is correct acid I swear that aay information which may bcreaftcr be given by me in hearings before tint Planning and Zoning Commission or the City Council far the City of Reaburg shall be truthful and correct. I agree to comply with all City regulations and State Iaws 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 pcmm t on approval iswcd under the provisions of the 2003 Inumational Code in cases of any false statement or mismpresontation of fact in the application or on the plans on whicb the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. 1 Signature of Owner /Applicant DATE ,Do you prefar to be contacted by fax, ennail or phone? Circle One WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRIJC'I'[ON SITE! Plan fees are non- relltudable and are paid In loll at the time of application beginning Janfraro L ZOOS City ofRexburg's Acceptance of the plan review fee does not constitute plan approval e c. 1 0,, 2001 11: 2901 Building Safety Department City of Rexburg 19 E Main janeUhOmburg,Org Phone: 208.359.3020 x326 Rexburg, 10 83440 www.rexburg.org Fax: 206.359.3024 Nu, 433'U P, 3 4 �,czsv * d o i CITY of REXBURG �'•, ,,� AmericasTmilyCommunity NAME PROPERTY ADDRESS l a LJ SUBDIVISI ©N Permit# Required!!! MECHANICAL Mechanical Contractor's Name: . � l� A9Je „��� Business Name: K S �a 1 eN' aAAC, Address 1 55.5 Lam- &A , A s i City � �-0- - �5 State _ Zip 83 Q D D, T Cell Phone: Business Phone: ( ) S — 1 7-? 7 _ Fax: ( Email L�, , )) )ew 0 S rL) - Mechanical Estimate S (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelli g Only) Furnace Exhaust or Vent Ducts 1 FurnacetAir Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas -fired appliance Incinerator System Boiler td Pool Heater V JY\- �_ Fuel Gas Pipe Outlets including stubbed in or future outlets Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic Mechanical Sizing Calculations mast be submitted with P lans & Agpjj don Point ofelivelX_ st be shown on p lans, sips �� dg Sipature of Licensed ConttacWr License number Date The City of R baag's permit fee schedule is the same w respired by the State of Idaho 09 Dryer Vents Range Hood Vents Cook Stove Vents '_ Bath Fan Vents other similar vents & ducts: �c� 6z -rnC\j