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3
C1T~' OF REXBURG ~ PERMIT #
BUII:GTTG PERMIT APPLICATION Please tom lete th~ -
1~ E MAIN, REXBURG, ID. 83440 If the question does not appy fill to NAorpnhoha a I cable
208-359-3020 X322 pp
PARCEL NUMBER: ~~ ~A V ~ ~ ~~~ J ~ (~,
06 00056
SUBDIVISION: UNI 328$ N 3000 W-Cray Mech
(Addressing is based on the information -must be accurate)
OWNER NAME: -tr ~ CONTACT PHONE # _ 3 f ~ _ ~~, ~
PROPERTY ADDRESS:y~~ ~ ~,~~ ~ ~~x ~ ~~~
PHONE #: Home (Zt~ ~ J,.3 ~'c3y ~, Work (~;;~j ,~~,~ Uvc;~ Ce1~1~j _~~~ ~ (~
OWNER MAILING ADDRESS:~,,~,~ ' ~ l~a~ CITY: ~(~ u STATE:~ZIP:~}
EMAII~.h~ IG~fZ. ~~ f/~~! ~AXc~~ N
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authortztfn~ applicant to act as agent for
APPLICANT INFORMATION: ADDRESS
STATE
ZIP EMAIL
PHONE #: Home ( )
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home# Work#
EMAIL
of
Work
must accompany this application.)
Cell
CITY:
FAX
-CITY ~ 1SV STATE~~ZIPyd
Cell# -
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Ad
FAX
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 a permit on approval issued under the
provisions of the 2000 Internatio al Code ' uses of any false statement or misrepresentation of fact in the application or on the plans on which the
pe it or approval wL~s,l a~ed. ermit v d if~t started within 180 days. Permit void if work stops for 180 days.
Do you
_~ U ~ l) i.i r.~~ f
FEES p Y ?Q06 ~~~
~~~~
DATE
ever 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 Rezburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
Please complete the entl~Application ~ If the question doesTiot appl fill in NA for non
applicable Y
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~.,"l. ~/L~tG /~ ~ Business Name: -~~ ~ ~ ~G
Address ,`~~ ~~l ~ ~(S~y ~ City ~(~ ~ ~ State Zip
,~'--'moo
Contact Phone: ~~) ~ C?~ ~ Business Phone: ~ ~,~,;~ G~ ~
Email, ' ~~~~~ )1,0.®,~7~ y~ ~~ ~~~ax_ ~/ .~
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace ~_ Exhaust or Vent Ducts
~_ Furnace/Air Conditioner Combo ~ Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
_~ Decorative gas-fired appliance
Incinerator System
Boiler
other similar vents & ducts:
p Pool Heater
Similar fixtures or A liances a ~~~
pp 1J~'~~ v~g~•t~
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply as Oil Co Fireplac Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~~ ~~~ J jj __
/ ~J
Signature Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State ofldaho
Range Hood Vents
Cook Stove Vents
Bath Fan Vents