HomeMy WebLinkAboutAPPLICATIONS - 08-00403 - 117 E 1st S - MechanicalOct. L. 200 1 0: 4LAM No.. 50 J P. IS bTY OF REXBUR PERMIT #
MECHANICAL PERMIT APPLICATION Please complete the entire Application!
14 E MAIN, REXBURG, ID. 83440 If the question does not apply fdl 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)
0W-MR k D 6r•d CONTACT .PHONE # _ 3 fl o _ 152lu
PROPERTY ADDRESS : 1 l s } S
PHONE #: Home ( ) Work (z°jw) e;o - 8 Cell (zs) 3 p g5 z f
OWNER MAILING ADDRESS: �STATE 2IF: _ 13
EMAIL 51, o �L . h 3-5 4
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 STATE; GIP EMAIL
PHONE #: Home ( ) Work ( )
CITY:
Cell (
FAX
CONTRACTOR:
MAILING ADDRESS:
CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
man hu ildinrss are heated nn this nrnne?rty?
Did you recently purchase this property? No Yes (if yes give owner's name)
Is this a lots lit NO YES lease bring co of new legal description of a
P S pY g p property)
PROPOSED USE: __2a
(Le., Single Family Residence,
tsi of rh <c
Remodel, Gm-age,
Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of pcdury, l hereby certify that I have
read this application and state that the information herein is correct and I swear that any information which vmy hereafter be given by me in hearings before the Planning
and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with ail City regulations and State laws relating to the
subject matter of this application and hereby authorized represcntWvcs of the City to enter upon the above•mcntioned property for inspections purposes_ NOTE: ltic
building official may woke a permit on approval issued under the provisions of the 2003 IntemationW Code in cases of any No Mnment or misrepwscntation of fact in
the application or on the plans on which th��it or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of fawner /Applicant
DATE
Do you prefer to be cJoMwk by fax, t9u1 of >) Currie one
WARMING — BUR DING PERMIT MUST DO: POSTED ON CONSTRUCTION SITE:
Plan fees are non - refundable and are paid in fail at the time of application beginning jgffVg v I. jW,1
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
OCT 02,2007 14:32 Page 2
Oct. 2, 2007 10:4201 No. 5017 P. a
Building Safety Department ���g x8u$ {a CITY OF
City of Rexburg U Y� RE_ _ UG
79 E Main lonellh @rexburg.org Phone: 208.3.54 -3020 x326 ,
`'•, ArwruiaTwmltyConunanity
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
NAME ,S x5 �ac 7 Co ( r
PROPERTY ADDRESS ll:] a j r4 Permit#
SUBDIVISION
RequxredW
MECHANICAL
Mechanical Contractor's Name: Business Name:
Address City State Zip
Cell Phone: { ) Business Phone: ( )
Fax: ( Email
Mechanical Estimate (Commercial/Multi Family Only)
F IV ,�RES & APPLIANCES FOUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Dryer Vents
Range Hood Vents
Cools Stave Vents
Bath Fan Vents
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical SiziAg Calculationj must be submitted with Pla s & A lieati n
Ro nt.of fthe verymust be shown a„n„plans,
Signature of Licenses] Contractor License number
The City Q, f R2t!z g's permit fee schedule is the same as
Bate
the State of Idaho
OCT 02,2007 14:32 Page 3