HomeMy WebLinkAboutAPPLICATION - 08-00506 - 5190 S 2000 W - MechanicalMECHANICAL PERMIT APPLICATION 'l ease complete the entire Application!
19 B MAIN, REXBURG, ID. 93440 If the question does not apply All in NA for non applicable
208- 359 -3020 X326
CONTACT PHONE #
PROPERTY ADDRESS: D J t�cx,r� (c� A1C caO
PHONE #: Homo Worts; (9$) (act
OWNER MAILING ADDRESS: S ITY: - STATEp
EMAIL
FAX
Og—
PARCEL NUMBER: (We will provide Wo for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the Information - must bo aecwate)
APPLIC9_ ,- (If other than owner;
(applicant if other then owner, s statement
act as agent for owner mu gt accompany
APPLICANTINFORMATION: ADDRESS CITY:
PHONE #: Home ( ) I Work ( ) Cell ( )
CONTRACTOR
FAX
MAILING ADDRESS: SI D= kA CITY STAT ZlP _RB%ot,
PHONE: Home# WorJc# EMAIL
STATE;
STATE; ZIP EMAIL
How many buildings are located on t]ti9 property?
Did you recently purchase this property? 8 Yes (If yes give owner's Warne)
Is this a lot split? a0 YES (Please bring copy of new legal description of property)
PROPOSED USE: � Q x
(i.o.. Singlc Family Reaidance, Multi Family, Apartments, Remodel, Garage,
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under pnWiy of pKJ Lwy, I beteby octl hm l bare
road this application imd swap tbet the intvtmglon huMin la eoltoat and I tweet thta any infotme10111 w01ch. may hereatberbe given by me !tt haulms batons me pleruft
end Zwing Civanitsion or Abe City Cowmil lbr the Ctky of Rexburg $441 be truO&I end cosreot. 1 We to eotnply with all City reguleti0ne and 6tate laws rolatingto the
aubieel metoer ofthls applloallon end hereby anthor/:ed reptnsentadves ofthe City to enter upon the above- mmlbned property br InspeCums purpoees. No76: Ac
building offlelel may 10ok0 a permit on approval luund under the pebvleioaa of ate 20031ntomatlonal Code im e asat of any £alm Ptatemomt or Of flwt In
the opplictelon or opt th on which Qte pormlt or SID royal wee ast d. PCnb1t void if bot started within 1 60 flays. PerMll veld Ifwork stop for 180 days.
:1�
Signature n( er /Appticem DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARMING — B'UMDING PERMIT MUST BE POSTED ON CONSTRUCTION SITEI
Plan feel ere non- ref'uadable and are paid In NII at the tlaoe of applioatian 8e1l4nla= raewalz 2, 2005.
City of Resbure's A0ee}ptaoea of the plan review The does not constitute plan approve)
Dot 16 2008
__4: 36PM
HP LnSER -JET_ Fnx
- 208- 656 -8938 _` _ P.2- -- -_-
Oct, 16 2008
3:39PM
•
No. 7204 P. 3
Building Safety Despartment 4 Ca OF
cti of i:.xbut J � REX
I9 6 mdn jonelfh0wourd.oro Phone: 208.3SV.302D x326 �
ArMA Parnily Correrntml))
Rexburg, 083440 www,fvxburg,orq fox: 208.3343024
IVAN[E 1 -b C
PROPERTY ADDRESS
SUBDIVISION
Require
Petrnit# f/;,. �—
MECHANICAL
Mechanical Contractor's Name: r ��uSW s Name; 5 o r
r
Address 3L� `0 City 4 State iD
Coll Phone: (, � 3 Phone, � :- "��� ����
Fax:
meebaoienl Estimate S I (Commereial/Muld FamHy Only)
M TURES & APPMNCES COUNT (Single Family DwelltAg Only
Furnace Exhaust or Vent Ducts
Fumacc/Air Conditioner Combo
Heat pump
Air Conditoner
EvapDnative Cooler
ITnit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Dryer Vents
Range Hood Vents
Cook Stow Vents
Bach Fan Vents
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical STARE Calculations must be submitted with Plans & An1211catioe
-k -�ml —) 0 Ito & e
of Lic rtsvd Contractor License natm er ate
The City offtburg permit fee schedule to the same as required by Me Stare ofldaho