HomeMy WebLinkAboutAPPLICATION - 08-00476 - 449 W 7800 S - Cnty Mechf I" t 'I "I" ri' I J uBll
2008 -10 -02 09:34 ADVANCEDHE 7"G
CITY OF REXBURG
2083573948>>
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208.359.3020 X326
11 V. 117 I 1
P 3/3
i s
PERMIT #
Please complete the entire Application!
if the question does not apply till in NA for non applicable
pARCEL NUMBER- f O�� (�, We will provide this for you)
SUBDIVISION: UNIT# BLOCK #__L OT#
(Addressing is based on the information - must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: r '
PHONE 0: Home ( ) Work ( ) n w Cell
OWNER MAILING ADDRE9S: CITY: � TATE: P: 2 - ;� q O
III, FAX
A,PPLvfCANT (If other than owner) (.t d ' - '1 Nt V - ., 1 �.
(Applicant if other tbw owner, a statement authorizing applicant t0 act as ageh0for owner must accompany th icadon,)
APPLICANT INFORMATION: ADDRESS S- b! CITY: 42'
STATE; ZIP t_�L� (EMAIL +is ► yec X FAX S �S
PHONE #: Home (v;W_7�{ S� - N Work Cell (3C �� - 's i to
CONT'T1IB 1
MAILING ADDRESS: r o�c N C1W STATE17) ZIPa'1 L ,
PHONE: Home* q c Work# ell#
EMAIL t� � S ,
Nnw man btuldinus 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
PROPOSED USE: L<JJ
(i.e., Single Family Residence.
of now legal description of property)
Remodel, Garay, Commeneial, Addition. Etc.)
APPLICANT' S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Uneer peaatty of w*M, t Aarebl/ Ct"* this I have
road this appNeauo0 ofd Stara ft the infw hereto is oareet end 1 swear that any htfbn ntm which may beroefEa be given by rite w beannga before dte Plasahtg
MW Zoning Comm dcm Of die City Council fBr the City of Rexbmg shell be mrddhl and awcct. I agree ro Comply wht► all City rePWOns ®td SM laws roldas to tb0
subjW matter of tWa epplioet and hereby mahortasd roplreKWWVes of ncc City a aura upon the abovPtrreidiogW ptgK* fbt lnspoodoes p xpow. NOTE: IU
building rind tnRy rovoke a permit oa approval Issued tmda the ptovisi0os of the ?A031raemabonel Codo bo dues of arty 1Sslse etetlrrtent a trda>+rlesdtggiao of file In
the appl' or Qe die p on wt1k11 d, permit w val was band it vaC Jnat started w 1110 deys� Pemril void f sups let 190 d dA ,L
of Owner /Appliem t (6 1 1 - C DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION 611TV
Plan tees are ton- r'efhodable and are paid in f it at the Uwe of appllcatlon beglauluft MOM= 1, 2Q10�
Cny of Rmborg's Acoeptante of the plan review he does not eoaseltute plan approval
2008-10-0209:011 RMBURG CITY OF Page 3
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2008 -10 -02 09:34
2083573948>>
Building Safety Department
CMy d 14xburg
19 E Main pnelth®rexburg.org Phone: 208.359.3020 x326
Rexburg. ID 8,3da0 www.r+exbu aOM Fax 208,359.3024
1 P 2/3
F
,WU �.� CITY OF
REX
'•, . Mo�ec�Y Er�n/G' Corr�n�eny'
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Requiredll !
MECHANICAL
Mechanical Conuwtor's Name: nk j1(1(`S IgCI W C 1 Business Name: i 1 Li Y' �rn nc.y is V i
Address �j lr ,�,� 1 City State An Q
Cell Phone: (, t)'j ' r.. ), ( iAn Business Phone: ( $�
Fax: a0b 7 s
Mechanical Estimate S .33H (Commerei"al i Family Only)
FDICT JI RES & APPLIANCES COUNT (Sintgle Fancily Dwelling Oily)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Range Hood Vents
Cook Stove vents
Bath Fan Vents
other similar vents & ducts:
Pool Heater
Fuel Gm Pipe Outlets including stubbed in or fitture outlets
Hae2 (Circle all that apply) eOi Coal Fireplace Electric Hydronic
Mechanical aWne Calculatigns must be submitted with FIgul & .A volication
Point of Delivery must beahowli Qn plans.
–C-11 L
Sigimm of Licensed Contractor Lice= number
7?9e Ctry ofRaxburg's permitJbe schedule b the sam as
the Store OJldaho
e
20W WO2 09:09 RD(SURG CITY OF Page 4