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CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
P
Please co 06 00153
Ifthe q„est,o 3885 Spring Creek Dr-Cnty Mech
208-359-3020 X322
PARCEL NUMBER: ~, ~+ 5~~..~~~i ( e will provide this for you)
SUBDIVISION: IT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
PROPERTY ADDRESS:
PHONE #: Home
OWNER MAILING ADDRESS:
EMAIL
~ t ~1 ~ ~ CONTACT PHONE #
iY'~_
Work ( ) Cell ( )
CITY: STATE
FAX
ZIP:
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home ( )
CITY:
FAX
Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name) ~~ ~ ~ ~ ~ u
Is this a lot split? NO YES (Please bring copy of new legal description of prope~~ MAR 2 7 2fl06
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition,
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 and I sweaz that any information which may hereafter be given by me in heazings 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 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 was based. Permit void if not started within 180 days. Permit void if work stops for 180 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 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 approval
w
Please complete the enti>~Application! If the question does apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~~ •„ ~ W~n;~) Business Name:
Address ~ ~ ~ City ~s--~~i-~" State -~-~ 1 Zip
Contact Phone: ( ) ~ Business Phone: ( )
Email
Fax
Mechanical Estimate $ (CommerciaUMulti 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
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
other similar vents & ducts:
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.
-, -
Signature of Licensed Contractor License number
The City of Rexburg's permit fee schedule is the same as
~2`~- ~ V~-mac:, (,~ C~
Date
the State of Idaho
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents