HomeMy WebLinkAboutBP & APPLICATION - 05-00278 - 3855 Mountain View Dr - FireplaceZ ~
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Rug 09 05 03:24p Myron Creager
Aug 09 05 09:53a
CI3'~ OF REXBURG
BUILDING PERMIT APPLICATION
19 E MAIN, RF.XBURG, ID. 83440
20&359-3020 X322
208-523-1196 p.2
p.3
PERMIT #
Please complete rile entire .Application!
if the question does not apply fill in NA for son appbt:able
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNITI; BLOCK# LOT#
(Addrt~siag is ba9ed on tfre information - mast be aeau~atte)
ow1vFR: ~ ~ ~, h ~, ,~. coNTACT PxoNE ~ ~ $ ~ _ ~ ~J ~ 9
PROPERTY ADDRESS:_~ ~~ S M ~ ~„ tea.- R a n ~, ~ t ~ ~ c' e
PHONE #: Home (obs) 3 ~' C - 3 ~1 ' S Work ( ) Cell ( )
OWNER 1iI.4Q.ING ADDRESS: ~5a,r,~~ CITY: e ~ STATE-~~._Z1P:~, 3~ ~ O
EMAIL F~
APPLICANT (Ifother than owner)
(Applicant if other than owns. a statement authorizing applicestt to act as agent for owner most accompany this apptica~otr<)
APPLICANT INFORMATION: ADDRESS /~ ~ .-5 ~ ~,; nc ,~ l,. ~p~ CITY:1 c~p~~,S .~al~~
STATE;_ ~ c~ r;,, ~ ~ ZIPS EMAIL FAX ~ -- ~) ~ ~ _
PHONE #: Home ( ) Work (a ~y_ ~ a ~~_ g ~- cam. Cell ( )
CONTRACTOR: ~
MAILIIYG ADDRESS:
PHONE: Hon>!e#
V1%orlc#
EMAIL FAX
CnY STATE ZIP
Cell#
How many beiildinbs are Located on this property`?
rna you recently ptu+drase this property? No Yes (If yes give owner's name) ,~ )-~
Is this a lot split? NO YES (Please bring Dopy of new legs! description of properly)
PROPOSED USE: , ~ ( n ~, ~, ,~,~ \
i.e S' '
., tngk Family Residence. Multi Fatuity, Apartrrrerrts, Remodel, Garage, Commercial, Addition, Etc.)
A.PPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under pemlty ofperjury, l hoebv ~~
Paz r have rtad this application and ~ ,~ the iurorrrotioa hereer is oorreet and ~ stivrar that any iaiao.~tion ,,,~. ~y harafber bn SAS by a~
io hearing befon: the Planuarg and 2:e•ing Cotamission m Ste City Couaal for the C:dy of Rrxbros shall t+e trothfitl sad
vrith all City reguha3ons and Stage laws wing to the ,object taasser of th's application acrd cotsecL ! ~ to O0`°Pb'
upon Wa above-meYttiorred property for inspectiars Purposes NQIE: 7'Ere brrilding official ~~ ~~ oEthe Crt~r m eager
>~' revoke a Permit on apprtrral issued tbtder rile
prw=i~ions of the 30001aterelatiaoal Code in eases clans false stataneat or _ d6ct is the app6cadoa a on the
p ~ r approval was based Parrdt roid Ff rmt started wi~in 180 days Permit void i1'worlc stops for 1gp days. ~~ as t~
rgtiattrre of Owrnr >•irent D~~~~~
Do you prefer to be contacted by fax, etn,ail or pho®e? Circle Ogre
WARNlAIG - BU1LDIlVG PERMIT 1bIUS7' BE pp6TEp ON CONSTRUCTION Si1TE!
Plan fees are non refaodable aqd are paid m 5d1 at the time r! application begiaaitg ,faasv )_ 2~ti
Cttp of RexDarg's Aeoepearee of the ~ rs+ie~r fee does ant e~oe ptaa approval
'' •Bt»Idirsg Perazit Pees are due at base sfapp6atioe•' r~BUilriw~ Ptr®its are void if yob cheek does oet clearrw
Rug 09 05 03:24p Myron Creager
.~
- rirxse a:umpie~e zne enure A-ppucat~on!
applicable
NAME ~ ~- c S ~ a n ~, c~ ~,~'
PROPERTY ADDRESS ~`?, ~ 1-,•i~ ,,; ~
SUBDIVISION
208-523-1196
If the questiea does not apply fill is NA for non
y~ ~~W Qom.. Permit#
p.l
.required!!
M~CFIA.NICAL
p 9~~.se~
Mechanical Contractor=s Name: C c..r~-~-pY..~ ~~; G r~ ~1` ~4Bt~ness Name: ~c~•n~.
Address_ ) ~5 a S ~' Z, n C n~ • ~ ~ City <. Il State.-~~ . Zip~j~
Contact Phone: (~~ ~ a ;~ -) ~ ~~ G` . Busirtess Phone: (a c~ .~ a . l ~1 c5
Email Fax ~~ ~ ~ ~ / J ~ (s
Mechanics! Estimate S (CommerciaUlliadi Famay On1sj ~,.b
F~XXT'URES & APPLIANCES COUN!' {Siiegle Fmttily ~mS ~+jY)
Funs Exhaust or Vent Ducts
FarnacelAir Conditioner Combo
Heat Pt,mip
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fucttrres or Appliances
_~ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) ~a~pil Coal plave Electric
Bath Fan Vents
other sitnilaz veins & ducts:
Mec>tanical Sizing Calculations mast be submitted with Plans & Application
Point of Delivery otust he shoR n on plans.
y~2~ g -~ ,- o~
igiratu~+e of Contractor Licer~sc oa~nbcr Date
Regal !
77re Ciry o~Rerfirug's pcnnit fee sc~dole is the some as requved by [he State of Idaho
Dryer Vents
Rangc Hood Vents
Cook Stave Vents