HomeMy WebLinkAboutAPPLICATIONS - 08-00315 - 1751 W 5350 S - New SFR Mechanical07/01/2008 11:41
2086247223
CITY OF REXBURG 0
CRAIN
PERMIT #
•
PAGE 03/03
MECHANICAL PERMIT ,APPLICATION Please complete the entike Application!
19 E MAIN, REXBURG, ID. 83440 if the question does not apply fill in NA for Iron applicable
208- 359 -3020 X326
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: -, per UNIT# BLOCK# LOT#
(Addressing is based on the inhrmation - must be accurate)
t/MJVC.K f-01 W CONTACT PHONE # -- I n S Z bSq — Ja_ n 1'1
PROPERTY ADDRESS: lJeS 5 �> D SDUtk
PHONE ##: Home ( ) Work ( ) Cell
O WNFR MAILING ADDRESS: 4S L i 6 E- Ul M- - CITY: P—I_ b STATE .= ZIP: ntl L�Z
EMAIL FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner most accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home (
CO TRAC O :
Work ( ) Cell (
CITY:
FAX
MAILING} ADDRESS: 2.1-{ 51 E, AJ , CITY
STATE :4' ZIP R3 4 1 1 4 S
PHONE: Home# Work #_"L Cell#
EMAIL FAX _JoZLJ — - ?Z2. 1 ., N
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)
PRO POS.I D USE:
(i.e., Single Family Residence Zlti Family,
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under penalty of perjury, I hereby certify that I have
read this application and state that the information herein is correct and 1 swear that any information which may hereafter be given by me in hearings before the Planning
2nd Zoning Commission or the City Council for the City of Rexburg shall be 1ruthfUl and Coffee[ 1 agree to comply with all Cary regulations and State laws relating to the
subject matter of this application and hereby authorincd representatives of the City to enter upon the above•mentioncd property for inspection 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 ty Plana 2n which the permit or AppmvRI was hmed Permif void if not started within 180 days_ Permit void if work stops for 180 days.
J LAA CO
- - ? I I / n 4
Signature of Owner /Applicant DATE
Q3
2
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUSS' BE POSTED ON CONSTRUCTION SITF1
Plan fees are eon - refundable and are paid in full at the time of application beginning Ayuam !,1005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
07/01/2008 11:41
2086247223
CRAIN
Building Safety Department
City of Rexburg
19 E Main
Rexburg ID 83440
NAME
janellh ®rexburg.org Phone: 208.359.3020 026
www.rexburg.org rox_ 208.359.3024
PROPERTY ADDRESS w , S 350 8
SUBDIVISION In
`,Q ylL• X U �•R
i
Permit#
PAGE 02/03
C 1. T V O T
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REXBURG
Arne rkak Awn fl Camn�r <rrih•
Required!!!
MECHA NICAL
Mechanical Contractor's Name: CLI V C d J M 6A Business Name: J ud tfn ltu + it
Address S 3 e . L 0 O N• City st. State :L c> zip n qt4c;
Ce ll Ph oac: (0 2-4 Business Phone: ( ) Z - I Lq to
Fax: ( ) 2 3 2. Email
Mechanical Estimate $� (romm.ereial/1Vlulti Family Only)
FIXTURES & APPLL9NCES COUNT (Single Family Dwelling Only)
I Furnace �^ Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater.
Space Heater
Decnrative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Dryer Vents
Range Hood Vents
Cook Stove Vents
3 Bath Fan Vents
other similar vents & ducts:
2 Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) S Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Ap licp ation
Point of Delivery
must be shown on plans.
Signa Licensed Contractor License Number Date
The City ofRexburg s Permit fee schedule is the same as required by the State ofldaho