HomeMy WebLinkAboutAPPLICATION - 08-00359 - 4218 Crossdraw Trail - MechanicalJul 21 08 11:26a Lisa Boozer
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CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 -3S9 -3020 X326
280- 523 -3306 p.3
No. blid Y. j
PERMIT #
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
PARCEL NUMBER. f We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accwatt:)
IN-
CONTACT PHONE # 7-q.1 — Z
PROPERTY ADDRESS: k7 — LV (_°,-d; :>".
PHONE #: Home ( ) Work ( ) Cell (
OWNER MAILING ADDRESS: CITY: / STATE: ZIP : 3 c
EMAIL FAX
APPLTCAN`I': (If other than owner) -- lit 4 , - L
(APplicaw if other thaw owner, a statement author>=g applicant to act as agegrfor owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 45 4 1 0 S,-, +—k A=wty, Nw�
STATE, ' -j ZIP .3 EMAIL FAX ZW S 2-0 3 �: y -.
PHONE #: Home ( ) Work -r Z z -� Cell
CONTRACTOR
MAILING ADDRESS: pia _ 2 1.1->l 1% CITY STATE ID Z IP 93'"?
PHONE: Home _ Work# Cell # Zti
EMAIL y '�I L I FAX
How many buildings are located on this property? 1 --
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:
(Le., Single Family Residence, Multi Family, Apartmcots, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty o pcq , I heresy cortiry teat
sad Z I have
read application and M w t les he City t the Uo herein !s correct and I swear that any information which may h=4cr be givcn by wo i bcariogs berbre th planning
r of ssi l t ha MC11 rtal j or the City CiRcuboig shall be truthftd and aorect. I Wee 10 comply with all City regulations and stare laws relating to the
subject mattc of leis application and 0.0 by authvriud tipro mbtires oftbe City to COW upon the above-mentioned property for iospectiams punwo. NOTE: The
building official m revo a pCrntit oo approvalissI under the pmvisioms of the 2003 International Code in cases of any false natemcnt or mistgn=UWGn of fad in
the applieatim or plans on whi was bawl PetmR void if not startcd within 180 days. Pdrait void if work stops for ISO says.
Si of Owner ]irant , DATE
Y pie be contacted by fax, email or phone? Circle One
WARNING — BUMDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in fall at the time of application Deeieaiag J1 7, Z S.
City of Rexburg's Acceptance of the plan review fee does not constiRutc plan approval
Jul 21 08 11:26a Lisa Boozer
Ju Z1. LUUO I I: jUAM
28523 -3306 P.1
No. 6718 P. 4
Building Safety Department
City of Rexburg
79 a moin jonellhemburg.org Phone: 208.359.3020 x326
Rexbvig, to 83440 www,rexbufg.org fox: 208.359.3024
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CITY OF
x REX
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'•e,, o •' Amerka3FwwlyGamnmwty
NAME - -7cX 1,56 J 4-41,
PROPERTY ADDRESS _�-i Ztt� �;„s y.J Permit#
SUBDIVISION Q: 'S I2 .' �
Required!!!
MECH"ICAL
Mechanical Contractor's Name: kle*\ `' .L i
Business Name:
Address wVy, , - City -, State 1?d Zip & 3'G
Cell Phone: (zxe tQ Z - 1{ y Business Phone:
Fax: (Z SZ — 3' ;�c,� Email
Mechanical Estimate $ (COt>amercial/1blultf Family Only)
FIXTU ,FS & APPLIANCES COUNT (Single Fancily Dwelling Qnly)
_ Furnace C Exhaust or Vent Ducts - 1 - 5
t/ Furnace/Air Conditioner Combo Dryer Vents rj
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Decorative gas -fired appliance KOC V-k) YY)8ri
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlet ocluding stubbed in or future outlets.
Heat (Circle all that apply) 4 (6� Oil Coal �1=lectric Hydivnic
Mechanical Sizing Calculations must be submitted with Plans & AnDlication
/1 �-- Z / - c �:
Licease umber Date
The City af.Rerburg's permit fee schedule is the sane as reWved by the State of Idaho