HomeMy WebLinkAboutAPPLICATION - 08-00471 - 3050 W HWY 33 - CNTY MECH0
CITY OF REXBURG
PERMIT #
0
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 X326
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: 'mP ► r tuts Z,- CONTACT PHONE # 5 q- Q (J J
PROPERTY ADDRESS: 300
PHONE #: Home (rte -� k (( Work ( )
Cell ( )
OWNER MAILING ADDRESS: �fO c() (,L) f4 ,3 � ITY: e STATE:_b_ZIP: 3yY0
EMAIL FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE: ZIP EMAIL
PHONE #: Home ( ) Work (
Cell ( )
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this 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 penalty of perjury 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 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 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 plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
T
Signature
Do you
9 / ' /
DATE
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
CITY:
I�:�
.
•
Building Safety Department X. rro
City of Rexburg 'y
19 E Main jonellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
Permit#
NAME
PROPERTY ADDRESS
SUBDIVISION
C I T Y OF
REXBURG
Amends Family Community
Zip
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
/" Furnace
Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Dryer Vents
Heat Pump
Range Hood Vents
Air Conditioner
Cook Stove Vents
Evaporative Cooler
Bath Fan Vents
Unit Heater
other similar vents & ducts:
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
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.
Required!!!
MECHANICAL
Mechanical Contractor's Name: Business Name:
Address City State
Cell Phone: ( ) Business Phone: ( )
Fax: ( ) Email
Signature of Licensed Contractor
The City of Rexburg's
License number
Date
schedule is the same as required by the State ofldaho