HomeMy WebLinkAboutAPPLICATION - 08-00584 - 1275 Twin Butte Rd - Cnty MechCITY OF REXBURG 0
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)
c� '7 1) -e CONTACT PHONE # 1 5`{ - `t SS�; 5 S
PROPERTY ADDRESS: 0-
PHONE #: Home (W - J54- LI - -S Work Cell - I I y
OWNER MAILING ADDRESS: 12-15
EMAIL FAX
F, —
APPLICANT (If other than owner)
(Applicant if other than owner, a statement
APPLICANT INFORMATION: ADDRESS
STATE
PHONE #: Home ( )
Work (
CONTRACTOR
CITY:
FAX
Cell ( )_
�C
MAILING ADDRESS: - �,:570 CITY
PHONE: Home# 3 — 69B� Work# Cell #
EMAIL
FAX IS q — 73
ri!�2 STATE 7� ZIP Se3 WO
3%
How many buildings are located on this property? Cdr»
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: `7-nc 1.4 6IAIA- l
(i.e., Single Family Residence, N ulti Family, Ap
applicant to act as agent for owner must accompany this application.)
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 thMians on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
V
ZIP EMAIL
%�J . CITY: Mz v� �v\. STATE: I D ZIP: Y3 `43 ` f
f -
DATE
Do you prefer to be contacted by fax, email o hone Circle One
WARNING – BUILDING PERMrT 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
i}
Building Safety Department
City of Rexburg
19 E Main jonellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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NAME Arv�wrc.,_;
PROPERTY ADDRESS (Z15 �$ - i w r� �3,,� -t t c i2-1 .
SUBDIVISION
Permit#
CITY 0 F
RXBURG
America' Family Community
Required!!!
Mechanical Contractor's Name:
Address
Cell Phone: ( )
Fax: ( )
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 Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal fireplace lectric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The
License number
's permit fee schedule is the same as
Zip
Date
the State of Idaho
MECHANICAL
City
Business Phone:
Email
Business Name:
State