HomeMy WebLinkAboutAPPLICATIONS - 06-00631 - 2736 S 6000 W - Fireplace12/28/2006 14:28 2085234638
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CITY OF REXBURG
MECHANICAL P E RMIT APPLICATION Please 1
19 E MAIN, REXBURG, ID. 53440 If the ques
208 -350 -3020 X326
LEISURE TIME INC PAGE 01/02
0 No. 3378 P. 2
0600631
2736 S 6000 W -Cnty .Meth
PARCEL NU?aER: -j9 Nf t l_P ) (We will provide this for you)
SUBDIVISION: UNIT# $LOCK# LOW
(Addressing is based on the information - mast be acme)
CONTACT PHONE #
PROPERTY ADDRESS :
PHONE #. klme ( s _�d d / 1r0� Work ( ) Cell ( )
OWNER MAMING ADDRESS �J & ZD QED W ., CI'I USTAM -79
EM FAX
APPLICR NT
(If other than owner) — I '- / 'A J
(Applicant if other than owner, a statement authorizin, applicant to act as agent fer owner must accompaW this application.)
APPLICANT INFORMATION: cc ADDRESS , W CITY:_ Alt
Zip C�W I EMAII, �Ld�� Sltir. — �(a�3
PHONE #: Home ( ) Work ( ) Coll
r -PMA —CTOM
MAILING ADDRESS: CIT <2A�� STATE
UU
PHONE: Hozlle# Work# Cell# 2�
e�"1�'\C�4�� w/
EMAIL FAX C' T� 1�
How many buildings are
Did you recently purchase this property? No Yes (If yes give ow -
�G���S�YI
Is this a lot split? NO YES (Please bring copy of new legal de
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, G=Se, Comtnertrial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under paWty ofpegwy i hcrcby ccrt& thlit l havc
reed tbls appliest w and smm tha the iatbrmatioe herein is correct and I mar char any hmrmadon which may hereaft be siven by me in beazSngs batm tho pbmnhrg
end Zoning Commission or ths; City Council for tho City of R¢xburg shall be ftthfW smd emeet. I aged to comply with all City mgdotiona and staid laws }o" to the
subjcat mentor of this application sad hz* aathorivrd t'cpnscnlativcs of the City to OW npa» the above - mxrW tied p.oporty for impectiow p,aposm NOTE The
building official may mokc a portrdt an tppmal inued under** ptovWonsa orthe= kmmn&ww Code in ame: of any &In Qmternent of raimrprescamdon of fact in
The application or on the plans on which the permit or approval was baled. permit void if not started within 180 days. Pmmit void if work seopn !ht 180 days.
SiFature of Owner /Applicant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WAR,NfNG— BUILD94G PERMIT MUST BE POSTED ON CONSTRUCTION SITE:
plan fees are non.refandable and are paid in full at the time of application beginning JagMM 1.,4005.
CRY of Rexborg's Aaceptnnee of The plan review fee does not conWHIme plan apprmral
on tws property?
01/02/2007 13:22 2085234638
3,2Jan, 2. 2007: 12:40%65234M
LEISURE TIME INC
LEISURE TIME INC 0
Budding $of* Department
CHY *f Roxbum
Rexd�tr�I,rro8�0 1�� ow Phone:
rgarg ftv 20MA3024
PAGE 01/01
No. 3399 N, i 92/02
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REXBURG
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