HomeMy WebLinkAboutBP & APPLICATION - 06-00257 - 4474 Cedar Butte Rd - FireplaceZ
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ay 25 06 11:35a Myron Creager 208-356-3988 p 1
~Cl~' OF RFXBURG _
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440 _
208-359-3020 X322 -
PERMIT # •
~~e~~e c®~l~~ete tie el~~~~e A~~p~~ca~~o~~
r~ il~e t =~1~
PARCEL NUMBER: ~I~,~~~.I~~~ ~~
SUBDIVISION:
(Addressing is based on the information -must be accurate
06 00257
4474 Cedar Butte Rd-Cnty Mech
OWNER: S~~ ~,,.,,~~~ ~ [~ y CONTACT PHONE # SSG,- 9~~ ~
PROPERTY ADDRESS:_ y ~J -7~/ ~1 ~ ,.1 ~j u ~I.~ ~~-.
PHONE #: Home ~g~:3S~-~~}~// Work ( ) Cell ( )
OWNER MAILING ADDRESS: ~~ ~r CITY: /~ ecfo ~ ~q STATE: ~/LIP=
--ter--
EMAIL g~
APPLICANT: {If other than owner) C' u s_7`_ - ,~ ~ ~ - ~ _ ~r
(Applicant if other than owner, a statement authorizing applicant act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS ~ S /° S• ~,(~~~ ~ Ty; >~ a ~~
STATE; ~~ ZIP ~~ f ~{D EMAIL FAX ~5~ - 39~'"~'
PHONE #: Home ( )
Work f~oE')_ 3 S5'-- ~,D Cell
COlYTRACTOR: ~ ~'~°~'.~..._ 5~.~s-,S~ ~- J=. i~~/1~ ~s
MAILING ADDRESS: 5'S ~ S.. `~P/J~vr•%~,.~.r ~'jU / CITy_ r~,~~~~STATE~ ZIP ~~y~~
PHONE: Home# Work# ~~5'~'-~~-$~Cell#
EMAIL FAX .x.56 '- .~~~ ~~
riuw „iany otu.a>tngs are 10CaLeQ on oils property'd
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? IVO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(t.e., angle FarniIy Residence, lVlulti Family, Apamnents, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT' S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjrety, 1 hereby certify that 1
have read this application and state that the information herein is cornct and I svrar 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 agree to comply with alF City regttlatious and State laws
relating to the subjoct matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned propetiy 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 Calse statement or
m~representation of fact in the applicatiorlor on the plans on which the permit or approval was based. Permit void if not started within 180 days. Pennii void ifwork
stops for 180 day~7 ~ ~~~
/ ~ ,t0 ~
Signature of Owner/Applicant u~ DATE
Do you prefer to be contacted b~g~email or phone? Circle One
WARNING - ING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning Jaauarv 1. 2005.
City ofReaburg's Acceptance of the plan review fee does-not coostiitute plan approval . -
Heat Yump
Incinerator
Pool Heater
Heat (Circle all that apply) Oil Coal Fireplat:e Electric
Mechanical Sizing Calculations must. be submitted with Plans & Application
Point of Delivery must be shown on plans.
~ Z~~
Si~nalure ul' ~ • sit CottLactor License nutttber
•; ~, :cam";.
The City of Rexburg's permit fee schedule is the same as
Date
the State ofldaho
3
5
y 25 06 12:03p Myron Creager 208-356-3988 p.1
~~ "~c~i,. :..,.~:. '': 'ii.~.~.~., ~~~~W ~°~~•~ ~~~"'~?~~~~~'~~~ r ~ the c:esEie,a do~3t apg~iy ~i~ :u lolA foa- 9zan
NAME ~. ,,.., ~ CL,~
PROPERTY ADDRESS .~ ~7t, ,QaZ
SUBDIVISION
Pemut~
MECHANICAL
Mechanical Contractor's Name: /I7 ~ ~,eG ~ Business Name: ~.~~ g,,,, ~~ ~s ~ /%,~
Address ~-SS ~ ~/,~,,~i"~,,,~ ~cn/ City ,,.~ State =~
_ 1 ~~ Zip~3 ~~b
Contact Phone; (~GY'j ~ S j - ~D~-~ Business Phone: ( )
Email
Fax ~ S~ -~ i°~~
Mechanical Estimate $ (CvmmerciaUMalti Family Oaly)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Air Conditioner
Bath Fan Vents
Range Hood Vents
Boiler
Cook Stove Vents
_~ Decorative Gas Fireplaces
Dryer Vents
Evaporative Cooler
Exhaust or vent ducts
l' Fuel (gas) piping fixtures or appliance outlets
Furnace
Furnace/Air Conditioner Combo
Meat Pump
Incinerator
Pool Heater
Heat (Circle all that apply) ~pil Coal Fireplace Electric
Space Heater
Unit Heater
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~ Z~~ ;3' ~a-S o
Si~aulur~ v " ' ~ s ~l Contractor L~censc number Date
_ ~~, _-3"
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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