HomeMy WebLinkAboutAPPLICATION - 08-00482 - 1121 Desert Rock Dr-BurrellC CITY F REYB R
O U G PFR +E
MECHANICAL PERMIT APPLICATION Pleas(
19 E MAIN, REXBURG, ID. 83440 If the qu
0800482
208- 359 -3020 X326 1121 Desert Rock Dr- Burrell Shop
PARCEL NUMBER: IBS) I"�- Icy (
SUBDIVISION: T UN i I # BLOCK# LOT#
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS: l / °�� -
PHONE #: Home ( ) �2_5 — 290 1 54ork
OWNER MAILING ADDRESS:
EMAIL
CONTACT PHONE
M
Cell ( ) , 49 �/ O
CITY:
FAX
STATE: ZIP:
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 CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR
MAILING ADDRESS: / 7 Gf/ , f/r CITY
PHONE: Home# Work#
EMAIL
FAX
STATE_ ZIP �
Cell#
How many buildings are located on this prop erty?
Did you recently p e this property Yes (If yes give owner's name)
Is this a lot splitC0 YES (Please bring copy of new legal description of property)
PROPOS —t E.
(i.e.,/Singie Family Residence, "1\Iulti Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPUCANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalt 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 C' Counc il 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 applicati and hereby authori r sentatives of the City to enter upon the above - mentioned property for inspections purposes. NOTE: The
building official ma revok permit on approval ' s e der the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or o the ans on which dte pe Wtvalwo as based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
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Signature caner/ phcant DATE
Do you p fer to 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
T
Building Safety Department
City of Rexburg
79 E Main janellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
of Rexevq�
CITY OF
RE XBURG
CW
America's Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name: �/V , B
Address City
Cell Phone: �� �` ��7a Business Phone:
Fax: ( ) Email
ICAL
C_ 7;0 zip
i
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES 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 Outlet including stubbed in or future outlets
Heat (Circle all that ap Gas it Coal Fireplace Electric Hydronic
r /
r� cxp
of Licensed ontractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho