HomeMy WebLinkAboutAPPLICATION - 05-00309 - 31 N 5th W - Plumbing' " C~ ~'Y OF REXB URG
PERMIT #
BUILDING PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208-359-3020 X322
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: _, CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home (~.• ~ ~~ ~~ ~~ ~G yl Work ( ) Cell ( )
OWNER MAILING ADDRESS: ,,,~/ ~(/~ ~1,~~- CITY: STATE: ~ ' IP: fr Z~
EMAIL FAX
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home ( ) Work ( )
CITY:
FAX
Cell ( )_
CONTRACTOR:
MAILING ADDRESS:
CITY
PHONE: Home# ~ ~ork# ° ,S"~ ~ ~~~Cell#
EMAIL
FAX
STATE~ZIP
How many buildings are located on this property?
Did you recently purchase this property? Yes (If yes give owner's name)
Is this a lot split? YES
PROPOSED USE: ~
(i.e., Single Family Residence,
(Please bring copy of new legal description of property)
~,~~
,/r ~
Family, Apartments, Re odel, arage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of penury, I hereby certify that I
have read this application and state that the information herein is cottect 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 cottect. 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 International Code in cases of any false statement or
misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work
stops for 1 days.
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Signature of C~lner/Applicants / D~T>:`
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
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Please complete the entire Application!
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Required!!! MECHANICAL
s~
Mechanical Contractor's Name: ~ ,."'Business Name:
Address City ~ ~- ~ r~~ State -~ Zip_~
Contact Phone: ( ) Business Phone: (Z~~ ~ ~c`f % ~~s~+f
Email
If the question does not apply fill in NA for non
Fax
Mechanical Estimate $ `'~ ~~(CommerciaUMulti Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Air C nnrlitinnPr
Bath Fan Vents
Range Hood Vents
Boiler
Cook Stove Vents
Decorative Gas Fireplaces
Dryer Vents
Evaporative Cooler
Exhaust or vent ducts
Fuel (gas) piping fixtures or appliance outlets
Furnace
Furnace/Air Conditioner Combo
Heat Pump
Incinerator
Pool Heater
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
Required!
The
License number
Permit#
Space Heater
Unit Heater
Date
's permit fee schedule is the same as required by the State of Idaho
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