HomeMy WebLinkAboutAPPLICATION - 07-00408 - 197 E 3500 N - Mechanical,p -of Rexaur`9/1�adason Coun--%
BUILDWO, PERt�iI3' APPLJ-,r1,',AT10N
19 E NTAIN, REXBURG,,
83440
208-359-3020 X322
IF
0700408
_N�Cn.
;1?
197 3500 ty.
Mec,h
PARCEL NUMBER. We will provide this for yau)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is basest on the informailon. must be accurate)
• �� �._ . — . -- _ . sa' - i � 1 -rte _ NTACT
CPHOS
0 WMA: t o 1/n I' i
y�0 0
PROPERTY ADDRE1S.S
C,
s -
PHONE1 : 0 Work
Cellh
MAILING ADDRESS: 3' --
-0CdY.
-i2 a �; �: ZP
Adr
fC)
vU
_x q
y
,o
EA4AIL C ��F'
AL21.1C.A.A.7; (Tf other than owner). -
(Applicant if ether than owner, a statement authorizing applicant to act as agent for owner must accompany this application)
APPLICANT INFORMATION- ADDRESS CITY:
STATEII ZIP................ FAX
J
CONTRACTOR -
I --
NIP
1 MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
1I RXI A Ta VAS
How many bu -i Idings are I ovate d on tis PTope1ty1?____
Did you recently purchase this
Is this a lot spiit?N� YES
PROPOSED USE:
(i.e., Single Family Residence, Mdm
property? No �ey�) (If yes giv;% olwaer's
'3
(Please bnng copy of new le
V!
Family, A
,:;al descriptioii.
9 Remodel, Garage, Commercial, t i Etc.)
P
0 L -'---N
APPLICANT'S SIGNATURE3, CERTIFICAIJON AND AUTHORIZ 0 A imally of perjury:, i hert;by certlf]v that IATI -N16 Under pl:%r
h2ve read this pt ,cation and state that theinformation herein is cor=ct and I swear that any info-nmation which rnay bereafter be given i
n hearings before the
.shallart. tV.1.
and State laws
relating to the subject mate of this applicaflon and hereby authorized reprcsentativcs of the City to enter upon the a in - •
ons purposes.
NOTE: The building official may ra permit approval issued underprovisions2000 In t *
spe
esof any t -ent r
misrepresentation fact in the applicafion or o i ans on which the p m it or approval was based. Permit void if n ays,erm .
f work
stops for 180 days;
S i r e/Apeficant
DATE
00 YOU Prefer fI contact�C1 by faxl- mofl- or phone? Cri
WARNLNG — EURDING PERMIT MUST BE POSTED ON CONSTRUCTION
Plan
fees r, naD-m - and are
paid
In full
at the tame of nbegIn-ningfamm,
City
ya's Acceptance
of the
plan
review
fee does not constitute lam approvaL
2
-. � } I ...� � � � R � ��'.;� • � � � � � � �� J � 1' eft` '
A
1p 1 0
-Z 0
fqp"VjLr-. ADD -0 1 vSS I I el � :7.
PROPERTY
z5UBDIVISION ` --'&�
3.
mech-arlical Contracto
Contact Phone: =
4 -
Email
1
Name 0
.
'
f � '
Fumace/Air Conditioner CoMbO
Fleat Pump
Air Conditioner
'ViEvaporative Cooler
Unit Heater
pace Reater
Decorative gas-fired app I*
FermzwT
;B Name:
UsIne
state
Business Phone' -Fax-
/ 0�f
Zip�C1X
7 •
A i �• W.FRI
Ir
,Yer Vents
Coo
k Stove Vents
'r B B -S
el?` - ath F an V en t
oth-er sh ni*lar vents & ducts:
incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pike outle�s i"ncluding stubbed m or futwe outItts
�Inlet Pressure (Meter SupplY) PSI
;r
Heat (Circle all that apply) Gas Oil Coal Fireplace leade
13
V-,
j f i i
i
Fate
Thi City of Rexburg's �����i� fey schedule is the sca�r� as required by the Stale of Idaho