HomeMy WebLinkAboutAPPLICATION - 05-00368 - 5148 S 2000 W - FireplaceOCT-03-2005 03:05 PM LEISURE TIME IDAHO FALLS 208 523 4638 P. 02
1.~ VAJ-~.t-i,lt~V 1 Lruvi-r e-u i s.a~. s11.~i. i iMMV V vv ~~~ ~r~ ~~-~~~ ~ -_ -.
I9 E IVIAIl~T, RE~LBURO, ID. 83~ ~f the gatestiou doge nat apply !n N'A for Qon applicable
208-359-300 X322
PARCEL NT.JMBE1t: (We will provide this for you)
5UBDMSION: UNIT#_____^__BLOCK# LOT#,
(Addressing is based on the information -moat be scouraoo)
CONTACT PHONE # .~5 SLQ
PROPERTY ADDRE
PHONE #: F>iome ~~)~~ -1~ ~9 In Work ( ) CCll ( )
OWNER MAILING ADDRE55: dJ I 1 g S: , Q W , CI STATI?~ ZIP:~~iyoV
ENIAII, FAX
d~Z`• (If other than owner)
(Applicant {.f othea cAan owner, a smnetne~t authorizing applicant to act a, want for owner must accompany this ~pllcs3ttion.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CDIVTRAC1;~.1t: ~,(
MAILINd ADDRESS:
FIIONE: Home# Wozk#''~ 013~e~l#
EMAIL~,~'_s_~r~~~c.~. +11s~ .._FAX f~~ ~ a~~l~
Haw many buildings are
oa this proPcriy?.
Did you recently purahese this pxoptrrty? No Yea (If yes give owner' g Warne)
Ia this a lot split? NO YES (Please bring eApy of new legal deeorlption of property)
PROPOSED USB: ~ v\ o~ D ~ C~AJu
(i.c., Single Ftnnlly lttss-denc~, M~Id Family, ApermreaDSe~,
ATE~QZIP ~~
Cotefmat~eW,
APPLICANT°S SIGNATURE, CERTIFICATION AND AUTHORIZATION; Under petnlty o£~~'> t hereby certlty that 1
have read this epplfatdoo end 9ttiDt+ prat the man .hrAr'Ci» is correct and 1 taear ttmt any indbrmatloe which may harc~lcr tst: given by me xn hetrriny beforo tlf e
t'lltnnSng ~md Zoeing Cormnisbion or iha City t:arecll fbr the Cirty of Rexlsurg shall be ttud~l sotd ~oateot~ I agree b oompy with all city ra~aiations and Stain leas
rcJatiog b the subjeet muter or this applicadon and hereby authoNaeA represmhRivee o~f the CNy to eraer upon the ehove•mendonad puopeny iot IQapaatJonii pwpoera.
NQTg~ The huildtn® offiaal may revoke a permit ari approval 9teued uttdar fhc ptrnrisions of the 2000 intetnalionel CoOe is oases odeay tbise statetamt or
misrepreaentatlao ot'teet m rho apDlfadlon or am the place on whioA the permit or npptovd wan based. Peemle void If not started wNtdn 160 days, 1'atrut void if work
stops for l80 daye•
3ignatzu~e of t~lwner/Applicant DATE
Do you prefer to be contacted by fax, e>~ail or phone? Circle One
~i'ARltl1NO - 8[JI4'DIlVG ~Rl1a1T MUST tiE POSTED ON CONSTRUCTION ~7~1
Plaa [oOe Are na~aretbtadlabh::od sra paW W !n!1 at the rims o[appflostlon b~nab<g
Ctty alReabtnE°e eiooeptae~ee a[tbe plan rttvlow flee dose net eenetthtte pine opProva)
CITY:
3
OCT-03-2005 03:06 PM LEISURE TIME IDAHO FALLS 205 523 4638
_Cct, 9. 200 1.21 PM ~ No, 1171 f
~''1~4~C 4Uiil~Iltl1.C 6Lt7 CL~II-ir Ei~~1LiW~tlU~4: u fee yue~n noes n~ppiy uii in ~~E- for non
applicab~,,.,
T~ANiI~ ~
PROPERTY AbDRESS ~ vJ• Pexmit#
SUBDIVISION
P. 03
Rega~~redlll
MECI~ANICAL
Mee~nical Contractor's Name: ~;- SL. ~r ~,~~~ o ,.nC . $usineSS Nan-e: ~~• Qom' ~ ~ ~ ~_ ~ ~'(~2 _~in C
Addrase Cit~D (~~~ F~(16 ~Q,St~te Zip X340 I
Contact Phoac: (; _ .;~ ~' Business P),aone: ~ )s~j~ - ~k l d ~, ~
Elnail~~ , ~ ~~,. ~ ~ ~~~~~ ~ ~-a ~-~,~n.3 ~ .
Mechanical F,atim$te ~• _ (CommerafaUMallf Family On1~-)
FDlCTTJ,RES ~ APPLL4IVIC,.E'S COlJ11tT (,S~ie~de F~~'~`y`y Dweddfiag O~aly)
Air Conditioner
Hat>,a Pan Vent
__,_____ Range Hood Vents
Boiler
Cook stow Vonta
~/ Decorative (3as Fireplacoe
Dryer Vents
Evaporative Cooler
Exhaust oz wont ducts
Fuel (Bas) piping llxtuted or appliance outlets
k~rna~ca
Fianace/Air Conditioner Combo
Heat Pwnp
Inoineratvr
Pool Heater
Heat (Circle all that appl ~__ ~1 Coal Fireplace Electric
Sgaco Heater
Unit Heater
N~iechanical 9~ing CalculntioHS must be submitted with Plans & Appllcstion
,.---, Point of Delivery mast be shown on plena.
1+v c. -~ - ~ ~~l
Uoonse number r pi~y0
Reguixed!
The Cfry ojRexbtng's permit fee schedttl® ~.e tAe same as required by the State
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