HomeMy WebLinkAboutAPPLICATION - 08-00365 - 5013 N 4000 W - MechanicalJul 25. 20OP-10:140 rst Call Jewel No. 1314) P. 1
CITY OF AHIB UR (4 PERMIT #
BUILDING PERMIT APPLICATION Please COlmn' lee the entire Application!
19 E MAIN, REXBURCI, ID, 8344.0 If the question d es not apply $ll in NA for non applicable
208 - 359 - 3020 X322
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the boformation - must be accurate)
omvix
CONTACT PHONE #
PROPERTY ADI,RESS: Q Q " o
PHONE # :14 ornc ( ) �`' ' Work ( ) ell ( )
OWNER MAMING ADDRESS. CITY: STATE: ZIP:
EMAIL FAX
APPS : (If other than owner)
(Applicant if other than owner a srai=eut authorizing applicant to act as agent for owner must- accompa nythis application,)
APPLICANT INFORMATION: ADDRESS �il' , o19�Q CITX: =1� —mss
STATE; ZIP 9-;?4143 EMAIL' FAX 502
PI30NE #: Home ` ( ) Work (. ) 5,a -772 7 Call )
CONT24CTO.R &,l.,�..(
1443LLINa .AD P") " CITY STATE_
PHONE. Home# Work#f a 22xcell#
EMAIL FAX
,1: buildings are located on this property?
Did you recently purchase this property? No Ycs (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„ Sk1gle FsVi lyRosidcnoe, Multi Fatally, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION ANDAUTHORIZATJON: unaetp <aairyofpooury,I hereb cen4 that I
have iced this appUcatioo and state tbat the iufottnndon horvin is correct pod I svrwihat toy lnformalionwhiah maylaoruflar ba o van by me is hearing before the
Planning and Zouing Commlaalon orthc City Cormcil for trbe City of Rexburg shell be &utwW and correct I agree to comply with all City regulations and State Ipws
alaftto the aubjcct matter oftbis appiionffoe and hereby nurborLMd reprtsenta&w of the Chy to eum upon tae above- mutloncd pivpnty foring ow ropoecs.
NOTE; tiro bufl ding official may revoke a permit on approval issrtcd wader rho ploviaiom of the 2000 Inremadonal Codc in cwm ofaayf state t or
mtsrepnssatatian offact3p the a➢plleationor oa the pl®s on wtllch thoyarolt orapproval was based. Permit voidifaol meted witBM ISO days. permit void if work
stops fol l a0 days- r
DATE
Do you prcf= to be contacted by fax, email or phone? Circle One
WMUq]NG BUILDING "AMT MUST SE )POSTED OIL CONSTAUMON ME
Plan fry ara non-refundable and aura paid In MU at tao tint of apphestion beenning Jamartr 1.3001
City of Roxhterg's Aeceptan co of tha play reran► tea does not cons0Uda plan approval
3
Jul.25. 2008 10:14AM First Call Jewel No.1314 P.
Jul, 15. 2005 2:22PM0 0 No, 0925 P.
Please complete the entire Application! u the q uestion do n ot apply all in NA for aon
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
- Requzred111 MECHANICAL
Mechanical Contractor's Name: j Business Name:
Address /)(() City State Li�
Contact Phone: ( ) �� —'Z 7� 7 Business Phone: ( )
Email Fax
Mechanical Estimate S (CommercialfMult! Family Only)
FIXTURES & AP.PZIANCES COUNT (Single Family Dwelling only)
F=ace Exhaust or Vent Aunts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
v' Pair Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater othex similar vents & ducts:
Space Heater
Decorative gas-'&ed appliance
Incinerator System
Boiler
i
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Sappy►) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace ]e '
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
41 ler 7�- a-5- .�,�p'
Signature o Licensed Co actor Llcenae nwnber Date
Required:
A e City of Rex burg's permitfae schadul a is the samty x required L the Store ofldaho
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