HomeMy WebLinkAboutALL DOCS - 12-00479 - 330 N 12th W #70 - Gas Lineng Sofety Deporlme
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City of Rexburg
Phone: 208.372.2326
Fox: 208.359.3022
CITY OF
REXBURG
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Americals Family Community
NAME
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Mechanical Contractor's Name
Addtess
Cell Phone () gusiness Phone (
Fax( )
Mechanical Estimate $-- (commercial/Multi Family o.ly)
FrxruREs & APPLTANCES couNT (single Family Dwelting onty)
Fumace
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
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Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure @Ieter Supply) PSI
Heat (Circle all that apply)R W [e*-1^--'z
Elecfic Hvdronic
License numberSignature of Licensed Contractor Date
BusinessName
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.city-State--Zip
Exhaust or Vent Ducts (water heater)
Dryet Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
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City of Rexburg
35 Northlst East
Rexburg, lD 83440
208-359-3020
Date:1012312012 - l1:08:05 AM
Transaction Number: 17 4291 1 6PT
Visa - XXXX-XXXX-XXXX-3304
Status: Successful
MECHANICAL PERMIT
Billing lnformation
Rachel Whoolery
,83440
195_90
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