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lov 14 05 01:05p Myron Creager
- CITE' QF REXBURG •
3UILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
208-356-3988 p.1
0_ 00447
Pleas 274E 1 st S - .Fireplace '~
If the q ale
PARCEL NUMBER: ~~~®~~~~ ~ (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE # .~~5~'-.
PROPERTY ADDRESS: ~ 7 Z/ d~, l ~-~ ~~~
PHONE #: Home (2o~j3sr-- A'SS' ~ Work ( )
OWNER MAILING ADDRESS:
EMAIL
Cell ( )
CITY: STATE: ZIP:
APPLICANT (If other than owner) ern ~ .~~,~,~ ~, /~ T,~1~~„~,.
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT NFORMATION: ADDRESS t`~ j f' ~. y,-l~lr..~ ~.~~ ~~CITY:~'a-~'-'~'S
STATE; y ~ ZIP ~% ~~ (~1~1AIL FAX ~ S~ - .~5'8~
PHONE #: Home {~
Work (~F) 3 SS' ~ ~n~- Fs'' Cell ( )
CONTRACTOR: C ~;~
/`.-rv
MAILING ADDRESS~~9 S•~1~~~¢-y~5y/ CTTY_ ~ox~~~f STA
PHONE: Home# Work# ~~{~~c~' Cell# ,
EMAIL FAX ~ SL, - •3 ~~ ~ 1
(1 ~ ,,.
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owners name)
'E~°~ZIP/~.~/fn
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
FAX
(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 t have read this application and state that the information herein is correct and 1 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. 1 apee 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. 1~OTE: 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 approv •a based. it ~f not started within ] 80 days. Permit void if work stops for l80 days.
Signature of Owner/Appl cant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARV[NG - BUlLD1NG PERMIT MUST BE POSTED ON CO~ISTRUCT[ON SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January 1. 2005
City of Rexburg's Acceptance of the plan review fee does not constitute plan appro~•al
'''*Building Permit Fees are due at time of application*'~ **Building Permits are ~•oid if you check does not clear**
Nov 14 05 01:05p Myron Creager
. Please complete the enti~Applicationi
applic:~ble
1~TE1ME ~ ~~ ~l ~/~ ~~~'~
PROPERTY ADDRESS ~-7 ~~ - / ~'~
SUBDIVISION
208-356-3988 p.2
If the gacstion doe~ot appl}~ fill in NA for non
Permit~#
Required!!! MECHANICAL
Mechanical Contractor's Name~~-^-~~~~` 4 ~'~,~~ ~ Business Name: /nJi~^~ ~'~`~
Address ~~ S. ~'l/~~~ %~i`cb,-> ~`i'~"'~ City ,~oc h~ ~~' State ~ >~ Zip' .
Contact Phone: (Jobe ~ ~`~~~-~ Business Phone: ( )
Email Fax ~s~' " Vii' (~~
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES CDUNT (Single Family Dwelling Only)
Furnace f Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Dryer V ents
Space Heater
_~_ Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
T 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
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.
.- ~ '
Signature of Lice ~' Contractor 1_icense number Date
Required'
The City of Rexburg's permit fee schedule is td~e same as required by the State of Idaho