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Home My WebLink AboutAPPLICATION - 06-00555 - 1 E 2nd N - FireplaceE3 0 v 09 06 04:03p Myron Creager CITY OF REXB URG BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208 - 359 -3020 X322 208 -356 -3988 p.1 • ( lease 4 0600555 If the q ues 1 E 2nd N- Mechanical PARCEL NUMBER: ()Jf -/ (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) OWNER: P Cc1,, J CONTACT PHONE # S�- SSo3 PROPERTY ADDRESS: �2 K J N PHONE #: Home ( Work( ) Cell ( ) OWNER MAILING ADDRESS: CITY: 6" STATE. - ZIP: % &" EMAIL FAX APPLICANT: (If other than owner) (Applicant if other than owner, a statement authorizing applicant to.act as�t for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS Y �1� / � ITY: 7 &A - - STATE, ZIP �' ��f� EMAIL PHONE #: Home ( Work ( Cell( ) CONTRACTOR MAILING ADDRESS: S'r ��!'�'� '9c rrY G�,�h _ STATE 7 d ZIP PHONE: Home# Work# �� Cell# EMAIL FAX 3 !!'> - -- -- 5 � 7 How many buildings are located on this property? Did you recently purchase this property? No 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 ofpcdury, I hereby certif that I have read this application and start that the information herein is con ect 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 - mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2000 lnternational 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 ifwork stops for 180 days. Signature of Owner/Applicant Do you prefer to be contacted by fax, email or WARNING — BUU DING PER Plan fees are non-refundable aad are I City of Rexburg's Acceptance r BE POSTED ON s N f �y tii �el f review oes not FAX / ty DATE g Jaiurary 2oo' l 1 approval 1: J. 3 Nov 09 06 04:03p Myron Creager 208 - 356 -3988 p.2 Please', complete the lYnt VApplication If the question docfoot apply fill is IAA for ijon applicable // NAME - - (- - ' g4 PROPERTY ADDRESS ( / N. Permit# SUBDIVISION Required!!! MECHANICAL Mechanical Contractor's Name: ��^ ��s Business Name: Address T5Q 7, o wT79� 90f City Ze,�,�,�.� State J , v�> Zip Contact Phone: ( ) J ss 'a Business Phone: ( ) Email Fax 3 f6 - i XM Mechanical Estimate $ (Commercial/Multi Family Only) FUTURES & APPLIANCES COUNT (Single Family Dwelling Only) Air Conditioner Space Heater Bath Fan Vents Unit Heater Range Hood Vents Boiler Cook Stove Vents Decorative Gas Fireplaces Dryer Vents Evaporative Cooler Exhaust or vent ducts r Fuel (gas) piping fixtures or appliance outlets Furnace Furnace/Air Conditioner Combo Heat Pump Incinerator Pool Heater 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. 2 oz /V Si�uaWre oEL nsect Contcachr License iwinber Date Required! The City of Rexburg 's permit fee schedule is the same as required by the Stat oL�daho '4