HomeMy WebLinkAboutAPPLICATIONS - 08-00338 - 653 Rolling Hills Dr - ElectricalJul, 10, 2008 12:54PM • • No. 6636 P. 3
CITY OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION Pleas
19 E MAIN, REXBURG, ID. 83440 If the q 0800338
208 - 359 -3020 X326
PARCEL NUM13ER: QFF-41 ogUU1 29 Sunset Circle Chlcos
SUBDIVISION: l
(Addressing is based on the information - must be accurate)
OWNER: 1 17/1_ ® CONTACT PHONE #
PROPERTY ADDRESS: /,&/ m aws - A 1_%
PHONE #: Home ) J,561'y717 Work( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
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 FAX
PHONE #. Home ( ) Work ( ) Cell ( )
CONTRACTOR A S /'1 1,7.71eoplep ev
MAILING ADDRESS: Z4(�,z Z96& CITY < STATE ZIP
PHONE, Homme# 35k-3_5A,5_ Work# ` d J,JJ Cell# g/,; °Z7�1?c--)
EMAIL FAX
Plow many buildings are located on this property? /
Did you recently purchase this propert�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:,
{ _e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
A$PLiCANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION under penalty of perjury, I hereby certify that I have
read this application ands at the information herein S5 cotrcct and I swear that any information which may hereafter be given by me in hearings before the Planning
and Zoning Commission c c City Council for the City o Rexburg shall be truthful and correct. I agree to comply with all City regulations and state laws relating to the
— 100 subject matter of is ap cation and hereby I th d esentarives of the City to enter upon the above - mentioned property for inspections purposes_ NOTE_ The
building official ay oke a permit on appro s d der the provisions of the 2003 International Code in cages of any false statement or misrepresentation of fact in
the application the plans on whirl! the oval was based. Permit void if not started within 180 days. Permit void i ork stops for 180 day , gyp
Signantrecruwnermpplicant ATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning January y. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
Jul, 10. 2008 12:54PM •
Building Safety Department
City of Rexburg
19 E Moin jonellh*rexbvrg.org Phone: 20$.359.3020 x326
Rexburg, 1d 83440 www_rexburg.org Fox: 208.359.3024
No. 6636 P. 4
oQ cSxHURC
'x
•, <<.PniO �fP1
CITY OF
REX
AmericaB Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
UMA
ICAL
Mechanical Contractor's Name: �'� Business Name:
Address Z� cf, P �.l City
Cell Phone: 7/ Business Phone:
s
y
Fax: ( ) Email
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace
Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Dryer Vents
Heat Pump
Range Hood Vents
Air Conditioner
Cook Stove Vents
Evaporative Cooler
Bath Fan Vents
Unit Heater
other similar vents & ducts:
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that appl Gas Oil Coal Fireplace Electric Hydronic
1AV_110__
License number
The City of Rexbwg's permit fee schedule is the same as
the State of Idaho