HomeMy WebLinkAboutBP & APPLICATION - 05-00446 - 75 S 5th W #45 - FireplaceZ
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lov 14 05 01:01 p Myron Creager
CITY GF REXB ~~RG
BUII~,DI~1G PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 8344'0
208-359-3020 X322 ,(~ (y,`~.-,/
PARCEL NUMBER; r ~ Cl Il/
208-356-3988 p.1
•
05 00446
Pleas
Irthe q 75 S 5th W #45-Fireplace
',~t711~ ~ (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
i!
ale
OWNER: ~~~ ~r1 y ~~ ~:, ~ CONTACT PHONE # ASS- /5'~p
PROPERTY ADDRESS: ~-5 5, ~"~ Cpl, ~~/S
PHONE #: Home (~a~j3S~' ~5~~ Work
OWNER MAILING ADDRESS:
EMAIL
CITY:
FAX
STATE: ZIP:
APPLICANT (If other than ovvner)~,-~_ ~ t~.k~ :e,,,~ 1<,~..~s
(Applicant if other than owner, a statement authorizing applicant to act as agenE for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS ~~g <S ; y,,,~/J®~;~ a,CITY: ,~i~6.,~'
STATE; ~~ ZIP ~~ ~ EMAIL FAX TJ6:.~°S'~
PHONE #: Home ( )
Work (~~)359 ~"G'~~ Cell ( )
CONTRACTOR ~ ~ 4 ~ 1J~s~~ ,~ F-:-~,pL<-~ r -
MAILII~'G ADDRESS: ~-F'~S-.QD//a~.~J`/~,y JO/ CITY ~c?,,~~~~.~ STATE ~t~ZIP~".~/~
PHONE: Home#
EMAIL
Work#~~>'--~'U~.~ Cell#
FAX ~~~~- .79~'
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's
)~~n~~ 1 4 ~ ~~
Is this a lot split? NO YES (Please bring copy of new legal descriptio$t of property)
[C. , _ __._., ___
PROPOSED USE: ""-"-~~ "-' -_w...~
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify
that I Stave road this application and state that the information herein is correct and 1 svti~ear that any information which may hereafter be given by me
in hearings before the Planning and Zoning Commission or the City Council for [he City of Rexburg shall be truthful and correct. T agree to comply
with all City regulations and State laws celating to the subject matter of this application and hereby authorized representatives ofthe 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 Tntemational Cade in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval was based. Permit void if not started within 180 days. Permit void if work slops for L80 days.
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 tees are non-refundable and are paid in full at the time of application beginning Janaan% 1. 2005.
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 check does not clear*~'
Cell ( )
Nov 14 05 01:01 p Myron Creager
Pease complete the ent~ Application)
applicable
NAME ~ ~.c~~-' J~~i~f~~
PROPERTY ADDRE S 7S~)- =` Gam'.
SUBDIVISION
208-356-3988 p.2
If the gaestion do~ot app)}~ 6l1 in l~A for non
Permit#
Required!!! MEC~IANICAL
r--
Mechanical Contractor's Na-m~e-: ~Y~ ~~-~~-~°;~/ Business Name: Cc- . ~- ~~•S~ >~~~~~~'
Address ~j ~.5~/~a~~'~1'c~~~~/~f ~i~P~ City dCroc~~~ r ~ State L ~? Zip ~'~ ~~
Contact Phone: (,1e-F')~-~%- ~'.~5~ Business Phone: ( )
Email Fax?S(~. `3i~8~`
1Vlechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace ~ Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Coolex
Unit Heater
Space Heater
_~_ 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
Drver Vents
Range Hood Vents
Cook Stove Vents
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~ttature of Lice~~sed Caitractor License number Date
Required!
The City of Rexburg's permit fee schedule is the same as regurred by the State of Idaho
5