HomeMy WebLinkAboutAPPLICATIONS - 08-00441 - 1076 Widdison - MechanicalCITY OF REXBURG 4 D
PERMIT # •
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 applicable
208 -359 3020 11 326
9
PARCEL NUMBER: (�J , t We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate) .
n
PROPERTY ADDRESS:
CONTACT PHONE #
PHONE #: Home ( ) Work
OWNER MAILING ADDRESS: r d ( 'y
EMAIL
FAX
Cell (
Z
22 Y, STATEzIP: -
APPLICANT (If other than owner) /k-VU
(Applicant if other than owner, a statement authorizing applicant to
APPLICANT INFORMATION: ADDRESS
STATE
PHONE #: Home ( )
ZIP EMAIL
Work ( )
this application.)
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
how many ounamgs are iocatea on tnis 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., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalt of perjur I hereb certif that I have
read this application and state that the information herein is correct and I 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- mentioned property for inspections purposes. NOTE: The
building official may revoke a on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or on the pl on w Bch the e r approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
1 1
Signature of Owner/ p scant 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 in full at the time of application beginning January 1, 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
as a nt for owner must accoi
CITY:
FAX
Cell ( )_
Building Safety Department
City of Rexburg
19 E Main ionellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
X9
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REXBURG
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Americas Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MECHANICAL
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Mechanical Contractor's Name: Lyb. � `f Busines&ame:
Address rty State Zip
Cell Phone: ( )
Fax: ( )
Business Phone: ( )
Email
Mechanical Estimate $ 00
(Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Space Heater
Decorative gas -fired appliance ou
Incinerator System
Boiler
Pool Heater + 5
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 & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho