HomeMy WebLinkAboutAPPLICATION - 06-00532 - 2863 E Hwy 33 - Mechanical-Cl`I`Y.OF REXBURG
MECHANICAL PERMIT APPLICATION
19 E MAIN, REXBURG,, ID. 83440
208-359-,'-3020 X326
PARCEL NUMBER:
SUBDIVISION:
(Addressing is based on the info
rmation - mustbe accurate)
Pleas 0600532 It
if the q 2g63 E HNvN--1' 33-Cnty Mecl1 ��e
OWNER -Mi
PROPERTY ADDRESS:S (0:3 j__
f, 1
PHONE #: Home Work
O)NNER MAILrIVG ADDRESS:��i�3
EMAIL FAX
je wlfiprovia-e-uff —yOUV
T# RLOCK;U LOT#
CONTACT PHONE #
CITY:
68,3,5.
Cel!w)-,I
STATEID—ZIP:
S
I= -
APPLICANT: (1f'other than owner)
(Applicant if other than owner, a statement authorizing applicant to apt as agent for owner must accompany this application.)
APPLICANT INFORMt1TION:
STATE* ZIP
PHONE #-. Home ( )
ADDRESS. CITY:
_ EMAIL FAX
Work ( ) Cell ( )
CONTRA CTOR:
MAILING ADDRESS: CITY NATE ZIP
PHONE: Home# Work# CeI14
EMAIL FAX
How many buildings are located on this property?I�.�,�
Did you recently purchase this property? �o des �Ifyes give owner's narraej{
i j1 UL Z
Is this a dot split? Na YES (Please bring copy of new legal description of`pra r�
p Y) �
PROPOSED USE:
74"%/ _n r! rn T- V n'l
(i -e-, Single Family Residence, Multi. Family, �partxner�ts, Remodel, Garagc, Corn�mezclal, A[�ditlt�
APP'LICANT'S SIGNATURE, CERTIFICATIONATI No n er 0 AND AUTHORIZ 0
read x application and state that the information herein. icorrect d I � � � r , hereby certify that � have
and swear that any Information n which may hereafter be given by i hearings .
Zrlin'ion r iY Council r the it�' Rexburg ����-� tf�� Planning
shall b truthful and correct. I agree to l with its, r
su'�je t matter f thisapplication and hereby authorized rye r' ent ti � � � regulations �� State 1���� r l�ti� t the
f pity to enter upon theabove-mentioned property ��r inspections
lid }fi i l - jt � approval � under the .6 'Purposes. NOTA` Th
the pliation or on the plans on which thr ��r�ernational Code in misrepresentationl �� �d. �rrn1t y
�fact ind f��t t� ithr� � �ys. Permitvoid if top for 180 days.
�er/A�
-----------
prefer6�gna ure"o wil
Do you to be coii cted
DATE
emailcoirl cted by fax, 'cT hone 9 C 4rcle
WARNING — 13UILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid "n full at the time of ap .6 W
'i of a bur � Acceptance o .r�� iw 5-
12
ilP2Sl". COMP ireApp]ICailOri�
fete the ent* .0 does6t question not apply fill In tiA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
i! Required!!!
M. E CHA A L
Permit#
Mechanical Contractors Name*
Business iVame:
Address
Contact Phone:
Email
City State ,��p�
Business thane;
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES &APPLIANCES CDUNT /Sinn/v Fnrr.fl,n,..,.nr.__ „__._ ,
Furnace
�� _.� Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heatex
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
X rVC g "lily)
:Exhaust or Vent Duct's
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan V
other similar vents &ducks:
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal ireplac Electri - Hydropic
Mechanical Sizing Calculations --must be submitted wit
Point of Delivery must beshownon in
Signature of Licensed Contractor
License number
M,99r, rfr4rva n,,
.- - - Im1w �-;- mh%x Mww �& w
Ions.
Date
The City ofRexburg '
s permit fee schedule
is the same as required by the State of Idaho
lication