HomeMy WebLinkAboutAPPLICATIONS - 08-00435 - 200 S 3421 W - Mechanical,0- 0
CITY OF REXBURG
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0800435
MECHANICAL PERMIT APPLICATION Please 200 S 3421 W- KIIngler House
19 E MAIN, REXBURG, ID. 83440 If the que;
208- 359 -3020 X326
PARCEL NUMBER: X39 �1_ o� - 11 fj ( W wi ll provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
_ CONTACT PH
' 1 ONE #
�
PROPERTY ADDRESS: 9 I V�-�
PHONE #: Home
Work ( ) Cell (
OWNER MAILING ADDRESS: CITY:
EMAIL FAX
STATE: ZIP:
PPLICANT: (If other than
owners �.�;
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS – P.O. Box 627 C1TY:Rigby
STATE; Idaho 83442 FMAII,hi ghcount htg, a?. Isc�ipe -cone FAX 2087450817
PHONE #: Home (208 )709 -4650 Work
)_same Cell ( )_same
CONTRACTOR
MAILING ADDRESS:
PHONE: Home# Work#
Cell#
EMAIL FAX
STATE ZIP
rzvw «t:u,y oulluings are l ocarea on rots 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:
(i.e., Singh; Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have
read this applicelon and s that th in fofmati on herein is correct end l swear that any information which may 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 all City regulations and State laws relating to the
subject matter of this application and hereby authorized representatives of the City to enter upon the above- mcntioncd property for inspections purposes. NOTE: The
building official may revoke a permit on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the aptication or on the plans on which the permit or approval was based, Permit void if not started within 180 days. Permit void if work stops for 190 days.
Si lure of Owner /Applicant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan few are non - refundable and are paid In full at the time of application beginning Jcnurary 1.2005
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
CITY
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u ding Safety Department
A
CNy of Rexburg x
19 E Main janellh ®rexbvrg,org Phone: 209.359.3 '
Rexburg, Q 83440 www.rexburg.org Fox: 2f.359.3024
NAME
PROPERTY ADDRESS
SUBDIVISION
Required!!!
MECHANI
C i ri o r
REXBURG
Ow
Americas raimly CAmpndgify
...Parmit#
� Vs-
Mechanical Contractor's Name: Steve Dick
Address P.O. Box 627
Business Name: High Country Heating
City Rigby State ldaho Zip 83440,
Cell Phone: (208 ) 709 -4650 Business Phone: ( 208 ) 745 -8056
Fax: ( 208 ) 745 -0817
Email highcountryhtg @netscape -corn
Mechanical Estimate $ (Commercial/Multi Family Ooly)
FIXTURES & APPLIANCES COUNT (Single Family Dwellin Only)
7 Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo l Dryer Vents
Heat Pump
2 Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
other similar vents & ducts:
Decorative gas fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) JGgs� Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & ,Application
Point of Delivery must be shown on plans.
— Steve Dick ! 6068 - .-
Signature of Licensed 06ntractor License number Date
The
's permit fee schedul is the same as rei
the State of Idaho
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
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