HomeMy WebLinkAboutAPPLICATION - 05-00369 - 3342 N Salem Hwy - Gas LineCity of RexbuYg/ Madisc~County PERMIT #
- BUILDINGPERMITAPPLICA'~'fON ~~1~~=_,- a~~K~r~,~x ~~~it`~ >~>~~i,~`tiii~~il.
i9 E MAIN, REXBURG, ID. 83440 -k~ =R~~; : ., ~ ~ ikt :.~ ~l~l-~ ~~~~a.71t,
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)
CONTACT PHONE # ~ ~ -- $ .. ~. a..
PROPERTY ADDRESS: 3 3 ~ ~ ilJ Sa I ~ :~~ I~
PHONE #: Home (avs)~l„ -sly aa- Work
Celt ( )
OWNER MAILING ADDRESS: ~.3~,~ /U .~ale~ ~ CiTY:~t~.r~,STATE: SD ZIP:~~a
AX
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing
APPLICANT INFORMATION: ADDRESS
to act as agent for owner must accompany this application.)
CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home
Work ( ) Cell
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home#
EMAIL
CITY
Work# Cell#
FAX
How many buildings are located on this property? r7
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: ~u.~~~ ~~,
(i.e., Single Family Residence, Multi Family, Aparttrt~ts, 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 aad 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 correct. 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 hrtematfonal Code in cases of any false statement or
misrepresentation of fact in the application or on the plans on which the pem»t or approval was based. Permit void if not started within 180 days. Permit void if work
stops fort 80 days.
/~/~
~igrta r of Owner/Applicant DATE
Teo yo~l rrefer to be contacted by fax, email or hone? Circle One
WARNING - BUII.DING PE ST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January I.200S.
City of Reaburg's Acceptance of the plan review fee does not constitute plan approval.
STATE ZIP.
2
,.,..~ . tl. -.~. A. _...~ ! „~Trb .,.Ww'~ re >> ..x• _ - ~ ._yz. A;?R 6 N+~ $ }'~-e...,.-r YO,
@ ~, `
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i 'M~,y;ry~.""f ~: 1. fd NiiliiM.: i,~ ~,lll r-; d.:xf ti i"x. ~.3 ~~x~1-w6 a.xv.:~. ~.., x.a .. ..~____, __ ~ ..,°:. .
i~.~rR~e~+.<a~.~fG
NAME
PROPERTY ADDRESS
SUBDIVISION
MECI~ANICAL
w ~ ~~ .~
Mechanical Contracter'c ?`?°~'°-^~ ~ ~ ~ 1 ~ t // ~C ~f ~ `_!~F~siness Name: `j'
~'
Address -- City ~ ~.~C -b ~~ 4__ ~~5 ~~~ =',.~l~Gr./7 Zip. > s~. e
Contact Phone: (j,,pg) ~5 w ~~ 3SUs Business Phone: (~pg-)~ ~ 1 `7 ~ ~f l ~ ~
Email
Fax
Mechanical Estimate $ 5 1 ~_ (CommerciaUMnIti 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
Decorative gas-fired appliance
Bath Fan Vents
other similaz vents & ducts:
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
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
;11L'112t11U'C UI LIC~i1tiC ,Oliit'aCic7i' ~,iCCiISC ilUDl'~~C Date
Permit#
Dryer Vents
Range Hood Vents
Cook Stove Vents
The City of Rexburg's permit fee schedule is the same as required by the State. of Idaho