HomeMy WebLinkAboutAPPLICATION - 07-00106 - 210 W 1st Nclrxvy Or REXB
URG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
PARCEL NUMBER
SUBDIVISION: -- r-� •.�� ��_� ��l y�u�
(Addressing is based on the information - must be accurate)UNIT# BUCK#
Please, c
If the q
uest
Elk River Custom Flooring -
Mechanical
WE Will nrnvirla +1.0� F
PROPER
PHONE #: Home
ER MAILING ADDRESS:—
L
F
Work
CONTACT PHO
NE
CITY:
110 Cell ( )
09 STATE:�ZIP:��
APPLICANT: (if other than owner)—
(Applicant if ocher than owner, a statement authorising applicant to act as agent for owner must accompany this appIycaiion.)
APPLICANT fNFORMATION: ADDRESS
STATE;
CITY:
QIP EMAIL
FAX
PHONE #: Home �( }
Work Cell
�i
C, ONTRACTOR
ifl
MAILING AD-DRESS:
01
PHONE: Home#
ork# C
_.
EMAIL
FAX
How many buildings are lo;
cated on this property?
VA
CITY 000p, UL -
-STATE ZIp
elh.Y'
R
Did you recently purchase this. pro-pertN Yes (If yes.give owner's name
Is this a lot sp��t? NO YES �Ple�se bring copy of new legal descri-Dtion of nrnnp,ft.�
PROPOSED USF:
multi. -tamity, Apartments
, Remodell, rCornmercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, a[ hereby ccrtrt�' that I have
read this app licatir�n and state that the infonliatrnn herein is correct and 1 swear That any information which may hereafter be liven by me in hearings b�farc the f'lan�x�ng
and Zoning Cormmission or the City Coe�ncil for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State lar��s relating subject matter of thi app�i�ation and he eby authorised representatives of the City to enter upon the above-mentioned property for inspections purposes, NATE: They ��
wilding offi ial y revoke a pe approval issued under the provisions of the 2Q03 International bode in cases of ani false statement or misrepresentatican o#' fact its
the applicati o on e plans o � e permit pt- approval was based. Pet�'t�Et void if not started «�ithin 180 days. Permit void if work stops for t 80 days.
0101
Signator of wnerlAp 'cant
ATE
7
Do you prefer to be con, ed by fax, email yr phone? Gircle Cane
WARNING —BUILDING PERMIT MUST BE PASTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January l 2005.
City of Rexburg's Acceptance of the plan review fee dais not constitute plan approval
Building Safety Department �R�BUR
19 E Main
Rexburg, 18344
NAME.
PROPERTY ADDRESS
SUBDIVISION
icineflh@rexburg.org
www.rexburg,org
City of Rexburg
cin : 208.3,59.3020 x326
Fax: '...
Required!!! ME
CHANICAL
Irk
I"E1) 1
PennU!#
Mechanical Contractor's Name; Business Name:
x
, R-ExBuRG
AmericFamily co??jmunity
Address CitY___...._.._State
p
Cell Phone,-, Business Phone: (
Fax-,
Email
Mechanical Estimate $ (Commercia]VMulti Family Only)
FIXTURES & APPLIANCES COUNT
Furnace
Furnace/Air Conditioner combo
I-leat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Neater
Decorative gas-fired appliance
Incinerator System
Boiler
(Single. Family Dwelling duly)
Exhaust or Vent Ducts
Drier Vents
Range Hood Vents.
Gook Stove Vents
Bath Fan Vents
other s�mi�ar ve�.ts & ducis:
Pool Heater
Fuel Gas Pipe Outlets 'ncluding stubbed in or future outlets
Heat (Circle all that applyGas it Goal Fireplace Electric Hydronlac
M chanical Siz4n C
alculations must be submitted Writ
n i7 Point of Delivery must beshown on n
ed Contractor
Li erase number
I I I I jw� I
1-1219 9 111 MV,
_ -EI W%I 1MVI & W
Tans.
Bate
The City cif 12exlaurg's permit fee schedule is the same as required by the State ofIdaho
I ication