HomeMy WebLinkAboutAPPLICATION - 08-00469 - 3974 Wagon Trail Rd - Shaw HomesUTY OF REXBURG PERMIT #
MECHANICAL PERMIT APPLICATION Please complete the entire Application!
19 IJ MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208- 359 -3020 X326
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
- JAC- C:ON'I ACT PHONE # :)gQ,SZOF2t 4
PROPERTY ADDRESS: t4 Wa 0 1� .�
PHONE #: Home
OWNER MAILING ADDRESS:
EMAIL
'rM
Cell( ) - OS-
CITY: STATE: ZIP:
AP,LICAN - (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this
APPLICANT INFORMATION: ADDRESS
STATE; 41F EMAIL
CITY:
FAX
PHONE #: Home ( )— Work ( ) Cell ( )
CONTRACTOR: Ae D
MAILING ADDRESS: tf- LI 1i - CITY �. �} STATE �'J zIP � 1 -f
PHONE: Home# Work# 2 - qJQJ Cell# .313- JpLq - 1
EMAIL
Huw many buildings are located on this property ?
Did you recently p ase this urch property? No Yes (If yes give owner's name.)
Is this a lot split? N® YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi
Work ( )
il-e Fai1n -i Icy
Apartments,
(jarage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of penury i hereby certify 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 berore the Planning
and Zoning t nrnmivdnn or the City Council forth* City of Rexburg shall be tAuthful 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. NO'rE: 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 application or on the plan which the permit or apDmval was based, Permit void if not darted within 180 days. Permit void if wurk stup9 fbr 18o days.
S
lop
ignature a Owner /Appli.can
Do you prefer to be contacted by fax, email or phone? Circle One DA I.L
WARNING — .BUILDING PERMIT MUST BE POSTED ON CONSTRUCTiON STTV
Plan fees are non - refundable and are paid in full at the time of application beginning A7 a 005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan Approval
Building Safety Department
City of Rexburg
19 E Moir) jane11h@rexburg -org Phone. 208.359.3020 x326
Rexburg, ID 83440 WWW rexhurg.org fax 208.359.3024
NAME _ 3 ha W
PROPERTY ADDRESS
SUBDIVISION
1I
C•I'TF o r•
REXBURG
, , Arywicos Fcm i !Y
1 � e)ntnnnrih.•
Permit#
Required!!! MECHANICAL
Mechanical Contractor's Name: - • Business Na
Address City. Zip
Cell Phone: (2bg) Business Phone:
Fax: Email
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family ,Dwell'. Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo_ Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
_.. _ Evaporative Cooler 3 Bach Fan Vents
Unit Heater
Space Heater
Decorative gas - fired appliance
Incinerator System
Boiler
other similar vents & ducts:
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) 6 Oil Coal Fireplace Electric Hydronie
P oint of Delivery must be shown on plans.
Signature of Licensed Contractor
lie -_
License nurnber
Date
The City ofRexbflrg's permit fee schedule is the same as required by the Stale of rdaho