HomeMy WebLinkAboutAPPLICATIONS - 08-00411 - American Manor Apartments - Gas Line-1 "1. 1Jr... 0
CITY OF REXBURG
MECHANICAL PERMIT APPLICATION
19 E MAIM, REXBURG. ID. 93440
209-359-30203326
PARCELNUNSER:
SUBDIVISION:
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Pl 0800411
g American Manor Apartments
Gas Line Repair
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UNIT# BLOCK# LOT#„
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TiAw�rr..r c CONTACT PHONE # - 5 (oS s -
PROPERTY ADDRESS: � _ .
PHONE #: Home ( ) '9Vwk ( ) Cell
OWNER MAILING ADDRESS: I' 7yK�e�ADS�aAsle
EMAIL FAX
(AppUe t if other than owner, a shumem author)zmg applicant to id w agent floc oww mum ecoomtpw
APPLICANT DWORMATION: ADDRESS CITY:
STATE ZIP EMAIL FAX .
PHONE #: Home ( ) Work ( ) 11 Cell ( )
COMU CTOR:
A/ IAILWGADDRESS:�b 1(,0q - ;- CTTY �+n' llc STATE Q_ZIP �a2
PHONE: Home# Worr# lwzy2il cut ll# 3 1 1 - S 'a.
EMAIL FAX
How many buildings m located on this property'?
Did you. re=tly ptuchase this property? No Xes (If yes give owBWS name) /A-
Is this a lot split? NO
PROPOSED USE: _
Q.o Sbglo Family Reticle
YES (Plem bring copy of ww legal descAption of property) M`q.
APPLICANT'S SIGNATURE, CTRTMICATION AND AUTHORIZATION: uww P=wofDodw,► I trot -dW*ft I b+.
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Do you prefer to be wnb cW by far, CM811 ar Phaoe? Chdc Ow
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Building Safety Department
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Mechaaical Estimate S (CalroMMi amIdti ]ram* Only)
MMURES A APPLIANCES COVNT (nrgk Fsmi& DH W MW O*')
Funmee Ekbaust or Vent Ducts _
FumacdAir Conditioner Combo Diyar Yeats
Heat Pomp Range Hood Vents
Air Condit3ow Cook Stove Vents
Evaporative Cooler Bath Pan vents
U nit Hester other similar vcnts 8t ducts:
Space Heater
Decorative gas-fired appliance
Incinerator system
Boiler
� Pool �•Icater
Fuel Gas Ape Outlets including stubbed in or future oudets
Heat (Circle all drat apply) � Oil Coal Fireplace Mat tic Hydwmc
Mechanical Contractor's ATatne '��e.�.rr�.� ,n Business Neese ��p, �2�W �t� 5 tc�l�.j
Address PA J6 69 _ G�ty �T�L.4,r� ,ll�_ �-` Z_ Zip Ya
Cell Phone: ( ) Business Phone: (2a ) ,6Y —qv yS
Fax: (�� v �� — � 3 0 1 F.»►m'3
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