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HomeMy WebLinkAboutMECHANICAL DOCS - 08-00134 - 37 S 4th W, A - Electrical & Basement Finish• • CITY OF REXBURG 0800134 1 , MECHANICAL PERMIT APPLICATION Plea. 19 E MAIN, REXBURG, ID. 83440 If the q 37 S 4th W- Stoker Ile 208 - 359 -3020 X326 PARCEL NUMBER: �_L� ( We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) OWNER I Fez - � � CONTACT PHONE # 1-M3 PROPERTY ADDRESS: - ; - 7 a) A y-r, A PHONE #: Home (zte) Work( ) fA Cell ( ) t44 OWNER MAILING ADDRESS: `J 1-17-0 PJ `A CITY: ' . gw, STATEEQ'� ZIP: 2 MQ EMAIL IA FAX 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 PHONE #: Home ( ) Work ( Cell ( CONTRACTOR MAILING ADDRESS: �2 X53 6 F= y ©o Al CITY S; 4NTH- ✓, PHONE: Home# 625/. �3 Work# 42 / -/5 /6 f Cell# y `® g-!✓ EMAIL FAX �'.2 Y 7- 2 -3 How many buildings are located on this property'? Did you recently purchase this property ?s Yes (If yes give owner's name) Is this a lot split ? YES (Please bring copy of new legal description of property) PROPOSED USE: IVI)Ly (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalt of perjur l 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 the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. ,e � t 15 / Z ( / Z CCO Signafure of Owner /App [cant DATE 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 STAT f, ZIP 53 FAX ❑ Bldg. ❑ Plumb. ❑ Elect. Mech. U Fire Inspection Request: Rec'd By Date Req. By T.1Q i Phone No. 7��`j� Project Perini( No. Address Inspection Type :E CS (��� ftc I((r _ Day /Time Req. �' c( Q Inspector's Report Z Res. ❑ Comm. . _ , D 1<: INSPECTED ITEMS CONFORM lb APPROVED DWGS ❑Y ❑ N [] N/A INSYR OR'S ACTION D� e,ODISAPPROVED [ FINAL ❑ C.O. (FINAL) ❑ NOT APPLICABLE ❑ DID NOT INSPECT ACTION REQUIRED: Signed _. /�i' Gc�L Inspector Rec't Acknowledged While - Office Copy *Now - Job Coq Pink - fly Copy F- FIR -CO03 _ *f\lcfrfl / \T *1117 TT/V 1f T/f� . INSPECTION TICKET ❑ Bldg. ❑ Plumb. ❑ Elect. 'f Mech. ❑ Fire Inspection Request: R ^�e1�cd By Date "_A Req. B -<< L Phone No. Project �n Permit No. Address r inspection Type Day !Time Req. C Inspector's Report ;d Res. ❑ Comm. INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑Y ❑ N 0 N/A INSPECTOR'S ACTION El APPROVED /6ISAPPROVED El FINAL ❑ C.O. (FINAL) ❑ NOT APPLICABLE ❑ DID NOT INSPECT ACTION REQUIRED: Signed Rec't Acknowledged White - 01ke Copy Vemow - Job Copy F- FIR -CO03 PW* - wdpoc «s Copy Building Safety Department City of Rexburg 19 E Main ionellh @rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax. 208.359.3024 o � gEXBUy u o CITY o F REXBURG __ OW __W _ , Americas Family Community NAME PROPERTY ADDRESS SUBDIVISION Permit# Required!!! MECHANICAL Mechanical Contractor's Name: Business Name: 7 - 0 b 60 46-#fIw6 Address ) V:5 3 6' 1 f oo /✓ _ City S`r Ad 6 /L/�'' State —Lb Zip , Cell Phone: (fag) 3 - 0 S5_5 Business Phone: (2,58 Fax: (.2&Z) G - 7a 2 Email Mechanical Estimate $ 1 c is. (CommerciaVMulti 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 Evaporative Cooler Unit Heater Space Heater Decorative gas -fired appliance Incinerator System Boiler Cook Stove Vents .2 • Bath Fan Vents other similar vents & ducts: Ct- RZ � Pool Heater 2 3' uel G s Pipe Outlets including stubbed in or future outlets Heat (Circle all that apply) as Oil Coal fireplace Electric Hydronic Mechanical Sizing C alculations must be submitte with Plans & A Point of Delivery must be shown on plans. Signature of Licen d Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho * INSPECTION TICKET • ❑ Plumb. ❑ Elect. ❑ Mech. ❑ Fire Inspection Request Rec'd By Date Phone No `� yi Projecct t Req. rr(J�7� � Permit No. 1 1 — r(X� Address Inspection Type Day/Time Req. Inspector's Report ❑ Res. ❑ Comm. INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑Y ❑ N ❑ N/A INSPEC R'S ACTION APPROVED ❑ DISAPPROVED ❑ FINAL ❑ C.O. (FINAL) ❑ NOT APPLICABLE ❑ DID NOT INSPECT ACTION REQUIRED: White - Office Copy Yellow - Job Copy — - °"v ""''''