HomeMy WebLinkAboutAPPLICATION - 08-00589 - Rocky Mountain TrailsCITY OF REXBURG
MECHANICAL PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the que
208 - 359 -3020 X326
785 S Railroad Ave -Rocky Mtn Trails
PARCEL NUMBER: (ON V?—
SUBDIVISION: UNIT#
(Addressing is based on the information - must be accurate)
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PROPERTY ADDRESS:
PHONE #: Home ( ) Work (
OWNER MAILING ADDRESS:
EMAIL
FAX
0
URRMIT #
0800589
CITY: 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 c
MAILING ADDRESS: (J, CITY 1 STATE ��f yZ --
PHONE: Home# Work# Cell# cg o W SO
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property( 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: A AndMO1r/>`
(i.e., Single Family Res ence, Mu tt Family, Apartments, 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 app oval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or on the plans on hermit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Ownet/Applicak ATE
Do you prefer to be 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
CONTACT PHONE #
U
1 4
Mechanical Sizing Calculations must be submitted with Plans & Annlication
..� ----� Point of Delivery must be shown on plans.
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Signature of Licensed Contractor VLicense number Dat
The City ofRexburz's permit fee schedule is the same as required by the State ofldaho
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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C I T Y OF
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America's Family Gommunity
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MECHANICAL
Mechanical) Contractor's Name: /'v/ Business Name:-,'
Address l `Dt� i City j
State — Zip
Cell Phone: Business Ph ne: ( )
Fax: ( ) Email
Mechanical Estimate $ .5 (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets ko
all h 1 it Coal Fireplace Elect H r ni
Heat (C a tat app y Ga C a ep ace ect c yd o c