HomeMy WebLinkAboutAPPLICATION - 05-00339 - 1003 Larch Dr - FireplaceCITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PERMIT #
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
PARCEL NUMBER: ,~I ¢ (We will provide this for you)
SUBDIVISION: i~icT'- UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: pa ~; d A-v~.~; ; ~c, CONTACT PHONE # Tr/~
PROPERTY ADDRESS: / ~ U 3 L, r /'~~ Dr - ~ a tZC,I1
PHONE #: Home ( ) ~ ~~~ ~ Va 7 3 Work ( ) -3G d'" a ~f ``~~ Cell
OWNER MAILING ADDRESS: S~ ~ CITY: ~~. h :. ,= STATE: ZIP:~~`~"~~
EMAIL
AX
APPLICANT (If other than owner) ~.~ ~s.l
(Applicant if other than owner, a statement authorizing applicant to
APPLICANT INFORMATION: ADDRES
--~-~- ZIP ~ `"~-~iviAlL
STATE;
PHONE #: Home ( )
Work
Cell ( )
CONTRACTOR: e~^ J'~'ia'[ ~ -~T r ~ -. j' `-~,~L`' °'~r
MAILING ADDRESS: ~Sg 5~ ~p/~a~s~..~ s~-~' CITY ~-~ ~~ ~ STATE -~ ~ ZIPg3`~'~'o
PHONE: Home# M~ V~'ork# X57'--~y~~ Cell#
EMAIL n~ Fj- FAX
How many buildings are located on this property?
Did you recently purchase this property'~Yes (If yes give owner's name) ~l D
Is this a lot split? ~ YES (Please bring copy of new legal description of property)
PROPOSED USE: 3~ 1, tF~ ~-~-
(i.e., Single Family Resid ne ce, Multi
Apartments, Remodel, Garage, Commercial, Addition, 5tc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: t;nder penalty of perjury, [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 Riven by me
in hearings before the Planning and Zoning Commission or the City Council far the City of Rexburg shall be truthful and correct. 1 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. MOTE: The building official may revoke a permit on approval issued under the
provisions of the 20001nternational Code in czses of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval was~Permi~d if~~tj~ed within 180 days. Permit void if work stops for 180 days.
i
Signature of Owner'Applican"t DATE
Do you prefer to be contacted bar 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 Januorv 1.2005.
City of Rexburg'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 ifyou check does not clear**
Oslo-3~~
as agent for owner must accompany this application.)
S~: ~~~'
CITY: /Ux w~~j.
F -~
M~
yep Og 05 04:29p
_ Please complete the enti>~Application!
apgilicable
NAME l? ~„ .~ ,4~...~~~.r
PROPERTY ADDRESS /~0 3 ~~ rc`. I;J~,
SUBDIVISION
Permit
Required!!!
MECHANICAL
Mechanical Contractors Name: ~7/ 'v~,t (.~. -.~-~5. ,v~ Business Name: (~-~~ l~T~~ k
Address ~5~ S. yC.~//~u.~ ~ ir~..~/~.~. ~ S v 9~( City ~~Cti~-g Stateyc~ Zip °J3`/~fv
Contact Phone: (,z~~ 359-~0~-~
Email
Business Phone: ~~-) s~~
Fax 3SG- ~9~~
If the question clout apply fill in l~A for non
Mechanical Estimate $ {CommerciaUMulti Family Onlp)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace!Air Conditioner Combo
Heat Purnp
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fxtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Ga Oil Coal Fireplace Electric
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
.26E 9- g~_Gs
igna re of ,icens ntractor License number Date
Required!
The City ojRexburg's permit fee schedule is the same as required by the State oJldaho