HomeMy WebLinkAboutAPPLICATION - 05-00355 - LDS Church - Water Meter/Lawn Sprinklerp,1
~'~7'~' OF RFXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
248-359-3020 X322
PARCEL NUMBER:
PERMIT #
Please complete the entire Application!
If the
SUBDIVISION:
(Addressing is based on the information -must be accurate
'-- ~" --- u A +'~.- nnn annlicable
OS 00355
Fireplace - 1 1 ~ Star ~/iew
OW'VER: ~~ ~ ~•,- ~~~~~~. CONTACT PHONE ~# 3/ ~-8.r~"~'
PROPERTY ADDRESS: It ,~- S j~rv:yw
PHOI~7E #: Home ( } ;3S9-o ~G 9 Work ( )
OZ'V1VER MAILING ADDRESS: / 1.~-S' i ~ v~ ~w
EMAIL
FAX
Cell ( ) 3 17 -~
CITY: ~~>.:~ STATE:~ZIP~'~yG
APPLICANT (If other than o~tner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: -ADDRESS CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR: G ~ T w. ~-rs ~`c,~a,~,~-~-~ s
MAILING ADDRESS: ~S~ S. ~.p/Iv~,~T.Q,~ffwy CITY ~'~ ~~,,~ STATE ~~ ZIP~3~ya
PHONE: Horne#~
EMAIL
Work# 3SS SO~-8~ Cell#
FAX 3Sp ' 3~~
How many buildings are located on this property? T
Did you recently p~urcrh~ase this property? No Yes (If yes give owner's name) X f/~
Is this a lot s ht? ~DI~ YES Please brie co of new le al descri lion of ro ert
P~ ~ g PY g P P P Y)
PROPOSED USE:
(i.e., Single Family Residence, Mutti 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 Cotnmission or the City Council for the Ciq~ of Rexburg shall be truthful and corcect, [ 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 ofthe ?000 ational Code in cases of any false statement or misrepresentation of fact in the application or on the plans on wfiich the
permit or approv vas ased. it v id if no tarted within 180 days. Permit void if work stops for 180 days.
/~ ~ ~i /~ iC~S
Sia ature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MOST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning /Qnunr~ 1, 2Q05.
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 if you checlcdoes not clear**
Sep 19 05 04:50p
Pease complete the enti>l~,pplicat~on!
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Requil~ed!1 ! MEC~A1vICAL
Mechanical Contractor's Name: ~~; .--~--~ C i-~~~~ Business Name: C'~STw~.~rl~..~ r~r-/ /L..~~-
r ~ ` !~
Address- ~~°r S ~~'//c ~r~~.z-~ H~~ ~9U~ City ~.:~ ~~~-~5 State ~~ Zi
P
Contact Phone: ( ) ~ Sg - ,~"Oa8` Business Phone: ( )
Email Fax 3S'6 ~ ~1f
Mechanical Estimate $ (CommerciaVMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Dryer Vents
Range Hood Vents
Cook Stove Vents
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
_~ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Bath Fan Vents
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~~ ~ ~~ ~~~
Si;nature of Lic ~ ontractor License number
Required+.
9y/9_vs
Date
The City of Rexbztrg's permit fee schedule is the same as required
the State of Idaho
p.2
If the question doc~t apply fill in NA for uon
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