HomeMy WebLinkAboutAPPLICATION - 08-00550 - Shaun Boice Office - Cnty Mechanical11/10/2008 01:02 FAX 2083592333 FIREPLACE BY DESIGN IM 001/002
Nov. 10. 2008 12:30PM • . No, 7363 P. 1
CITY OF REXBURG
1vIECHANICAL PERMIT APPLIC Please c permit #08 00550
19 E MAIN, REXBURG, ID, 83440 Uthe gaesti Shaun Boice Bldg -Cnty Mechanical
208 - 359 -3.020 X326
PARCEL IViJT?B Cj u F,� 0 15La I (We will provide this for you)
SUBDIVISIOIN: UNI _BLOCK# LOT#
(AddroWng is based on the information - must be accurate)
ACT PHONE #
PROPERTY ADDRESS: t
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX .
APPLICANT (If other than owner)
(Applicaat 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 A Homo ( ) Work ( ) Cell ( )
CONTRACTOR Acd* —
MAILING ADDRESS:_ CITY
Family, Apartments, Retnodel,
PHONE: Home# ' v�li Work# Q ' , Cell# 3j� el-1 ?a
- EMAIL FAX 4 a? W
How many buildiAp are located on this pro
Did you recently purchase this pmop No es (If yes give owner's name)
Is this a lot split? NO lease bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single FanmilyUsidence,
APPLICANT'S SIGNAT
read this application and state dW the
and zoning Commission ar the C
Subject matter of this appii mtd I
building official may revoke a
the application w on the plains c
Signature ofOVK
Do you prefer to
STATE /ZIP d:e c P'
Etc.)
7 CERTIFICATION AND AUTHORIZATION: under paaalt of pct ..N I hereby certify that I have
f tian herein is correct I sw any inibrnmtioo which may be adtcr be given by no inh=civgs bclbte ft .Plant bg
far We City of Rcxb and oormt. I agree to comply with all City regulations and State laws relating to the
midwiud r City to enter upon the above mentioned property for taspeadoaa piuposes. NOTE: The
approval" ad - ,dF of tho 2003 h temational Code in cases of aqy false statement or mistapteeenn pion of fact in
the void if not swrtsd within 180 days, Permit void if work chops for 180 days.
ATE
bb euntacrted'by fax, anaiil' or 06m? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and mire paid in full at the time of application beginning lux= 1.2001
City of Reatbarg'g Acceptance of the plan review fee does not coastitute plan approval
11/10/2008 01:02 FAX 2083592333
Nov, 10. 2008 12:30PM . 0
FIREPLACE BY DESIGN 9 002/002
o. No. 7363 P. 2
Building Safety Department
City of Rexburg
19 P- Mein jonelih ®rexburg.org Phone:, 208.359,3020
Rexburg, ID 83440 www.rexburg.org Fox: 208.359.3024
a °4uo4
CITY OF
`p RM
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
PHASE LOT BLOCK
.Requir
Mechanical Conttactoes
Mechanical Estimate $�� mmescial/ u1ti Family Only)
FIXTURES &APPLIANCES UN'P (Slagle Painily Dwelling Only)
I+urn=
Furnace /Air Conditionet Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Exhaust or Vent Ducts
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Decorative gas -fired appliance .
Incinerator System
Bolles .�
Pool Heater
Fuel Comas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that app Gas ' Coal Fireplace Electric Hydronic
Sd of UAmCConb4tor License number Date
Thr
chednk it thr aawr at rv&Ay & Swe of uA60
Cell Phone ( ) _3�,?-/ 7a Business Phone
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