HomeMy WebLinkAboutAPPLICATIONS - 08-00427 - 252 Gary Dr - MechanicalSep 08 08 02:14p
Sep. 4. 2; 51PM No. 6974 P. 3
CITY OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION Please complete the entire Application!
9 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for Rolm applicable
209-359-3020)026
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be asemate)
p.2
OHMR: Phs 1=arriiss CONTACT PHONE#
PROPERTY ADDRESS: Z5 Z Gio. r c
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE ZIP: Z 3L ko
EMAIL FAX
APPLICAN7' (If other than owner)
(Applicant if other than owner, a statement authoriaixng applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
CITY:
STATE; ZIP EMAIL FAX
PHONE #. Horne ( ) Work ( ) Cell ( )
CONTRACTOR
MAILING ADDRESS: 4 w . St CITY - idaic 1 c4 Is STATE ZIP 8340'Z
PHONE: Home# Work#
Cell#
EMAIL FAX
How many buildings are located on this property? I
Did you recently purchase this property]) Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of properly)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Rernodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty ofpajwvj, I bereby c ffy that t have
lead thin application asd sink ibrt the information berein is eatma std 1 swear that my k* madon wb ich may hereatter be gives by win beariop beinn the Planning
and Zoning Commission of the City Council Lot the Chy of Raftag shall be truthful and comet 1 epee to comply with all City regulsioas and Sate laws relating to the
subject mmer of this application and hereby authorised mprese*Wva ofibe City to ester upon the abovo- mcationed property for inspecdans putpotes. No7E_ The
boildntg official may rovoke a permit on approval ironed tmdet the p mimm of lice 7.003 lMaoWwd Code in cases of arq false atatanrnt ar inivaptcseatatsco of fact is
chin apprwd - tun on the phw m which the permit or sppmval war based Perms void ifnot started within l tt0 days. Permit void if wmlr stops far 180 days.
7 X67 L- c1 / / 0
Sivnahne owner /Annlirant DATE
Do you prefer to be contected by fax. email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUMON SITE!
Plan fees are nos- retwodable and ore paid in &H at the time of application beginning Grp j. 2095,
City of Resbarg's Acceptance of the plan rr4ow Do does not constitute plan approval
Sep
08 08
02:14p
Sep.
4. 2006 2:51PM
No. 6974 P. 4
p.1
Building Safety Department
City of Rexbvrg
19 E Main joneM@rexbmg.org Phone: 206.359.3020 x326
Rexburg 083440 www.rexburg.org Fox 208.359.3024
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NAME R u
PROPERTY Al
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: e 0 n A rN 3y1 c, Business Name:
Address ZCi W • ($kh City --! C4 full state Zip
Cell Phone: (20) ' Business Phone: (Z08) 62
Fax: ( ) Email
Mechanical Estimate S (CommercizYMalti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dweffing O^W
-- 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
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 Sizing Calculations must be submitted with Plans & ADDHatiion
Point of Delivea must be shown on plans.
�9 ®nature of Licensed Contractor
Dryer vents
Range Hood Vents
Cook Stove Vents
Beth Fan Vents
HVG- el- 1512
License number
The City ggce Vg . 5
schedule is the saute as
the State of Idaho
9 y 10F
Dat