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HomeMy WebLinkAboutAPPLICATION MECHANICAL - 17-00371-17-00373 - 720 Cornelison Ave - Juniper Sands Apartments - Bldg 1-3y��y BCp, luildin laf4Usaztmont y C I TY C F P HUIIHINGHEHNII.1W HM 41gilityoFAe�lbllr� z� r I — °N's 1u;'°l° :19 No rd :1st last A>narica:e f-'rrnriiy Cnrnnnenin Aembi rg, Idaho 834,19 BUILDING AHA LIIIA IM PI Misoallan no z u All eail anioal Wosk For Office Llse Hermit Nllniber: ❑ Mecl anical Fees Paid 1. lrc]lertyllumer Flame:t- l_ddress: ©it r: State: ail Code: 11 one: 11midir Ilial a Building Incl], a he mii ownai is alis y ecl to da } ❑nI c i to eir ewi hems. i re tlou a homeowner daing warl- oa ]lour own home? 0 Yes (skip t,l 11 A an i ca mplete t] a Ho meortlner's Ealemltiaa] 1ANo, I am workin with the homeowner "Techanical Contractor Ain([ r It la! II BculdinA I lock a . egbitared .ontriactar Mi.lat Cie U a wt i kj j . a 11 nlmal i fai Huil1 ling. L 4 Husiness: �`JL j� lav kn l { 4� t LLQ State License V: Exp.: Address:���d-� ,_C_C, ti: Citr:1r4�S�is �� �+L� _State: �3 lip fade: ty` Rhone: Lk7,�} ?z �.. __.._. _ lmail:s�t� ti-C�=a•• Oontact/llefl.Name: _ ��t .� �• Phonne:Ljg:�- lc�L{ Fniail: Mechanical IontractordutlorizedSignature: late: ll i A copy ofyour state registration/license Is required to be on ftle, !f this is the firs time you hove clone work in the City o/'Rexburg, Idease provide a photo copy o,hpur license. PJj)pu are unsure if) lour license is iin jile, please check til lith the F ermit Vchnician 1y callina (2 08) 172-.1341. 3. Prcject Ilescrilltioa A ddress ' r kco ►2-T"A 91-%•M -OR- La 1:.—... Blocl #1: -_._ 9u1 djAsi an: Wl at tyll a of 1 r+1 r erty: al esi• len tial ❑ qa mnlercial 4'lstafjat: $ � Di � SGC IescniptioIll (if werk: 4. Fees: 111ecl alltl atall ply: ❑ . urnace or API = 1115 rl Eirellace,llSelid Huel Hnrninj iluit: ❑ Gas Line = $(15 a Huilt-in = $130 Water Heater = $ 15 Q Hree-stardin.1= $ 15 r Miscellaneous/Reqs I ested Ir slj ectil n = $6 S Inspertion Jkes can he huddled upon request. .1 e-inspect,Pes will he entrced if inspection requests exceed fee totals. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjurll, € hereby cerlif that I have read this application and sr: to that the information heroin is correct and I swear that any information which may hereafter lie given by roe in hearing;: before. the Planning and Zoning Comm issiun or the Cil-• Council for the Ciry of Rexbtirg shall be truthful and correcL I agree to comply Huth all City regulations and State la%ns 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. NOTF.i The building oflcial may revoke a permit on apprnval issued under the provisions of the 2012 International Code in cases of dny false statement or misrepresentation of fact in the application or on the plans on which the permit or approval vias based. Permit void if not started within 180 days. Permit void if uiork stops for 180 days, FI licallt's Name [print]: `' -h :lid Signature e f t1L6 --u tl Date: Inspections must he tilled N bel re 8 AFI on tl a day the inspection is requeste I. Inspection requests calle I in al er 8 AM wa li be scheduled 6 r the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341