HomeMy WebLinkAboutAPPLICATION - 05-00426 - 123 Marianne Dr - Fireplacev 01 05 12:53p
CITY OF REXBURG
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PERMIT
Pl• - ~ -'
[f t 05 00426
Fireplace - 123 Marianne Dr.
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83410
208-359-3020 X322
PARCEL NUMBER:
tion!
-Iirable
SUBDIVISIOl~: UNIT# BLOCK# Lu t~
(Addressing is based on the information -must be accurate)
~ZPRst~cR~:,T~ ~~~
DWNER: ~{~«,,,,~
~, ; ®~ s~/~.L~~ C~~ CONTACT PHONE # ;~ `--~;,~._~~/- 90~
PROPERTY ADDRESS: ~ 02 /' f ~u CG •, n ~ D i
PHONE #: Home (2af) ,35~ ~ `/g 33-
OWNER MAILING ADDRESS:
EMAIL
Work
crrY: /~~~-
FAX
Cell
STATE:SIP: ~~/Y~
APPLICANT (If other than owner} ~a 3 ~ `u]~~~ „ ~%1,,~/„ems
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner musLt accompany this application.)
APPLICANT INFOR_v1ATION: ADDRESS ~S ~ ~ - ,~//J~`Ts=..~ ~~ CITY: ~~ d ~ ~
STATE; ~~' ZIP ~`3/'yU Ey1AIL FAX 3Sl -.~~~"
PHONE #: Home ( ) Work ( )~Sf'-a`CU~'' Cell
CONTRACTOR : C'~ 3 i e,,,.~ ~-~~ ,. G-~-~-~t'_-.-~-r
MAILING ADDRESS: s`3 ~ 5'. c~~//~,,,~~1,~-~~`~~CITY ~~- - STATE~~ ZIP ~3~lfv
PHONE: Home# Work# ~~-fil"y~~'Cell#
EMAIL
FAX .~>~ -3 9
Nnar many hnilrlinac arr. Inr.atPrl nn thic nrnnPrtv9
Did you recently purchase this property? No Yes (If yes gi~~e owner's name) 1~QV - ~ ~~05
Is this a lot split? NO YES (Please bring copy. of new legal description of prope ~~ ~~)C~Uf3~
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT' S S IGl\ATURE, CERTIFICATION .AND AUTHORIZATION: Under penalty of perjun•, 1 hereby certify
that I have read this application and state that the information herein is correct and [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. [agree to comply
with all Cih• 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. DOTE: The building official may revoke a permit on approval issued under the
provisions of the 2000 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval ed. ~ of started within 180 days. Permit void if ~r•ork stops for 180 days.
' ~ ~~ I U ~ / ~F7Us
Signature of Owner/Applicant DATE
Do you prefer to be contacted by 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 Januan• 1. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
**1uilding Permit Fees are due at time of application'~* "*Building Permits are void if you check does not clear**
Nov 01 05 12:53p
Please complete the ent~ Application!
applicable
NAME ~~- ~° ~-. ~ .-.. ~ ~--~fv~
PROPERTY ADDRESS 1~3 n'l~C;-~,. H-e
SUBDIVISION T~
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If the question does not apply fill in NA for non
05 00426
Fireplace - 123 Marianne Dr.
Requited!!!
MECHANI ~,~1.
Mechanical Contractor's Name: may, ~.,., ~,s~,,~ ~,~ Business Name: <<~T~~ ~S ~, ems...--%
/~ s
Address ~ ~ % S ~//ow-~~e..:. l-F~y ~ o/ City ~~c ~ ~ -4 State ~ ~ Zip3~`l~~y
Contact Phone: (~~} 3Sg ~o~g Business Phone: ( ) 3~~--T
Email ~(~" Fax ~ ~' C~ '~~
Mechanical Estimate S (CammerciallMnlti Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace; Aar Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler ~ ~ ~ ~ ~,,~;~
Pool Heater
~Q~ _ 1 ~~~~
Similar fixtures or Appliances
~~ Fuel Gas Pipe Outlets including stubbed in or future outlets ~~~ 0~ (~EXBURG
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.
~~ ~~ _
Signature ofi _~c~d Contractor
Required!
The City of Rexbur~'s
~~~~
License number
%~= ~ ~~
Date
it fee schedule is the same as required by the State oJldaho
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