HomeMy WebLinkAboutAPPLICATION - 05-00381 - Rexburg Surgical Center - Fire Alarm & Fire Suppression System
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~~ C.ITY OF ~ ,.. x ~ Wyk Y,. ~~ ~ a ' ~ {~ 4 '' ~ ~ ' ~ ;
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REXBLIRG .r~ ~s ~ ~~~_~rfa ~ ~ .
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.~ AMERICA5 FAMILY CJ.MMUNFI Y 19 E. Main St. Phone: 208-359-3020 x326
~, Rexburg, Idaho 83440 Fax: 208-359-3024
www.rexburg.oro cdd@rexburg.org
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:_
PERMIT APPROVED: YES/ NO
APPROVED BY:
BUSINESS NAME:
$50.00 FEE PAID: YES/NO
OFFICE ADDRESS: 1(,~ Z. T~a.~ .~ ~E ~ E~~~ 2~ l'0 ~ 3 yYv
City State Zip
OFFICE PHONE NUMBER: (zD~) 3 ~~ 230
CONTACT PERSON: ,.~ ~~~~ CELL PHONE # (2~) 3`~ V z L 6 7
-LOCATION OF WORK TO BE DONE:
STREET ADDRESS WHERE WORK WILL BE DONE:
BUSINESS NAME WHERE WORK WILL BE DONE: !2 c-a ~ A .5} oc c ,Q i~ 5
DATES FOR WORK TO BE DONE: ~`t- 'vs TO /~-~ly 'oS
CONTACT PERSON: ~d ~...,,~..~..~ C.. )a-r-4a~.>
PHONE NUMBER: (;
CELL#(266) 3~[~ ~l.G'7
PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR:
C'f AUTOMATIC FIRE-EXTINGUISHING SYSTEMS
^ COMPRESSED GASES
C~FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT
^ FIRE PUMPS AND RELATED EQUIPMENT
^ FLAMMABLE AND COMMBUSTIBLE LIQUIDS
^ HAZARDOUS MATERIALS
^ INDUSTRIAL OVENS
^ LP-GAS
^ PRIVATE FIRE HYDRANTS
^ SPRAYING OR DIPPING
^ STANDPIPE SYSTEMS
OS 00381
Surgical t~enter (.Fire Const. }
RY MEMBRANE STRUCTURES, TENTS, AND CANOPIES
!7
AP SIGNA URE DATE
6