HomeMy WebLinkAboutAPPLICATIONS - 08-00410 - 343 Harvard Ave - Fireplace08/25/2008 22:37 FAX 2083592333 FIREPLACE BY DESIGN
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- A u9'.'26 2008 , 8;43AM yj — N'o, 6926 V .2
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MY OF REXB URG
PERMIT #
00
MECHANICAL PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID, 83440 If the question does not apply. fill In NA for non applie"
208 -359 -3020 X326
PARCEL NUMBER: (We will provide this for you)
SLTQDIVISIOIV: UNIT# BLOCK# LOT#
(Addressing is based on. the information - must be accurate)
vwly��r; f7LG ZV11- , CONTACT PHONE # _
PRO ADDRESS: _ _5
PHONE #: Home ( ) 3yd0 Work ( ) Cell ( )
OWNER MAILING ADDRESS; CITY: STATE: ZIP:
EMAIL FAX
APPUCCANT: (If other than owner)
(Applicant if other than owmer, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE, - Zip E1IQAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR;
M
MAILING ADDRESS fy � CI'T'Y - L STATE ZIP 63Y
PHONE: Home# ? � Work# — 7 Cc — ,Y/
EMAIL FAX
+ivw ivauy vrur.unigs are locamerl on ills 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)
PROPOSED USE:
(La., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT' S S IGNATURE, CERTIFICATION AND AUTHORIZATION Under p enalty of perjury, I hereby certify brat I have
read this application and statc that the i0muladon harein is cammt and I swear that any Wormation wbioh rainy b==Acr be given by me m hefting& befow the planning
mad 2;onimg Coamdsaioe oir the City CemKd for the City of ReadxV shall be tsttfl" and correct- I agree to comply with aU City regatatiow and State laws relating to the
subject inciter of 's ' lion and hereby authanzed representatives of the City to eater upon the aboveaentmed property for imspec*w purposes. NOTE: T
buildinB oInci y obe a permit on i des the provisiws of the 2003 )mean bzW Code in cases of an fairer. stdcmmt a
the appiicati or the pleas ao whkh the rpvnl was based. Permit void if not started witbin l $o days. Permit void if wank stop& far 190 w of feat in
? iX i ad'
SipatuA Of OwnIV AMIicen i t DATE
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 to fall at the time of application beginning Januery 1. 2001
City of Rexburg'& Acceptance of the plan review fee does not constitute, plan approval
=. " 08/25!2008 =22:38 FAX 2083592333
Aug, 26,' M8" 8 43A
FIREPLACE BY DESIGN Q 003/003
No. 6926 P. 3
Building Safety Department
City of Rexburg
19 E. Moin jone11h6mxbur8.org Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax: 208.339.3024
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0800410
343 Harvard Ave - Morton
Requtredlll .MECIY"I
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Mechanical Contractor's Nairn _ ✓h C� Business Name/1 Al2roy
Address �iil City State Zip
Cell Phone ( ) ql 7 `7f 70 Business Phone
Fax ( ) Email
Mechanical Estimate $ `k (Commercial /Multi Family Otdy)
FLKTURES & APFLL4NCE8 COUNT (Single Fau2r7yDweWho- Only)
Furnace
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Bailer.
Exhaust or Vent Ducts .
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents . & ducts:
Pool Heater
Fuel Gras Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Metel.SW=10 PSI
Heat (Circle all that alp Ga Coal Fireplace Electric Hydronic
of Urenscd Contra or •ccnse number Dste
The
schedak xr the saws as rvqu red 8 the