HomeMy WebLinkAboutAPPLICATIONS - 06-00602 - 3028 S Paradise Ave - New SFR MechanicalCITY OF REXBURG ...
MECHANICAL PERMIT APPLICATION Please 0600602
19 E MAIN, REXBURG, ID. 83440 If the qu( 3028 S Paradise-Cnty Mech
208-359-3020 X326
PARCEL NUMBER: .C) f 0 �l_V V-` 0 1001 OS (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE #
PHONE #: Home ( ) Work ( ) cell( -OS as
OWNER MAILING ADDRESS:,Z69 q!::; JX0 - CITY: Y: J�R KL(IW STATE:JIZIP: Q LAgo
EMAIL FAX�R� f
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement
APPLICANT INFORMATION: ADDRESS
STATE; ZIP
PHONE #: Home (
CONTRACTOR:
MAILING ADDRESS:
act as agent for owner must arAompany this application.)
CITY:
EMAIL FAX
Work (
Cell ( )
CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL
How many
FAX
are located on this property?.
Did you recently purchase this property? No Yes (If yes give owner's
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have
read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in hearings before the Planning
and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws 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. NOTE, The
building official may revoke it on approval issued un a ovisions of the 2003 International Code in eases of any false statement or misrepresentation of fact in
the applica jgan o nth_ on which the pSp" allpr6val based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
�Z)0i o &
DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January 1, 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
Building Safety Department
City of Rexburg
19 EMain ioneilh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
NAME
PROPERTY ADDRESS
SUBDIVISION
Required!!!
MECHANICAL
Permit#
C I T Y OF
REXBURG
OW
America's Family Community
Mechanical Contractor's Name: Business Name:
Address Cl `,' (� City (Jr- cJ in State � - Zip ^t
Cell Phone: Qp S R Cj— 11 Cl Z R Business Phone: to %
Fax: ( ) SZ Z- -1 ��� Email
Mechanical Estimate $ 0 d-6(Commercial/Multi Family Only)
FIXTURES & APPLLANCES COUNT (Single Family Dwelling Only)
Furnace 0 � Exhaust or Vent Ducts 15
Furnace/Air Conditioner Combo h,' Z Dryer Vents � V
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Range Hood Vents
Cook Stove Vents
Bath Fan Vents 0 C)
other similar vents & ducts:
Pool Heater
�Z Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
,(2 0 1
License number
12 l0 ? /0
Date
The
schedule is the same as
the State