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CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
rrr~a.rTT -FF h• ~~~~
Please c
If the quest
PARCEL NUMBER:_kQ~UO~ ~~~ (V~
SUBDIVISION: UNIT#
(Addressing is based on the information -must be accurate)
BLOCK# LOT#
PROPERTY ADDRESS:
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL FAX
CITY: STATE: 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
CITY:
STATE; ZIP EMAIL
PHONE #: Home
CONTACT PHONE #-
v ~'~ ~'
Work ( ) Cell ( )
Work ( )
FAX
Cell ( )
CONTRACTOR:
MAILING ADDRESS: /tL~ ~ ,,,,~~~ CITY
PHONE: Home#
EMAIL
Work#
FAX
Cell#
~STAT~~ ZIP
~~
How many buildings are located on this property?
Did you recently purchase this property Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(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 have read this application and state that the information herein is correct and I 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. 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-mentione property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions of the 2000 I ernational Co in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval a ased. P,,e id if not started within 180 days. Permit void if work stops for 180 days.
~/ ' / ~
Signature of O ner/ pp icant 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
**Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
06 00309
159 S 3rd E -Mechanical
Please complete the ent~ Application! If the question doe~t apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Required!!!
MECHANICAL
Permit#
Mechanical Contractor's Name: C ~ Busi ess Name
Address ~~T ~ f.~li/ Ci State,
Contact Phone: ~~ ~~~- ~~~O Business Phone: ( )
Email 3~~ `~-~ Fax
Mechanical Estimate $ 7Commercial/M lti ~i_ 1~0~]i ~
FIXTURES & APPLL4NCES 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
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply Gas it Coal Fireplace Electric
Dryer 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.
ignature of Licens Contractor License number Date
Required!
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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