HomeMy WebLinkAboutAPPLICATION - 06-00577 - 305 E 3rd S - Fireplace`ad1v 22 06 02 :08p Myron Creager
CIT. Y OF REXB URG
208 - 356 -3988
. BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 -359 -3020 X322
P.1
Please 0600577
If the que 305 E 3rd S- Mechanical
PARCEL NUMBER: r(�il� ('. _
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home (aLz5) L 54 7Y 'Y'
OWNER MAILING ADDRESS:
EMAIL
Work (
) y9 � - I g 351 cell( )
CITY: L� STATE: ,TZ ZIP - 5 jf // '
APPLICANT (If other than owner) �-
(Applicant if other than owner, a statement authorizing applicant to act aas gent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS ?- ::"' S -7 �� d� 4/ CITY: /&� �T
STATE; ZIP 3 ��yy EMAIL
PHONE #: Home (
FAX 35 3 ST_
Work ( ) 3ST`' Cell(
CONTRACTOR K', A , a
-�-lr
MAILING ADDRESS: �7 0 G/ CITY 16�L✓f, STATEriD ZIP /4 �
PHONE: Home# Work# : 26P0__ Cel1#
EMAIL
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, CERTIFICA'T'ION AND AUTHORIZATION Under penalty ofpetjury, l hereby certify that I
have read this application and state that the information herein is correct and 1 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 ofRexburgshall be truthful and correct. I agree to comply with.aU City regulations and State laws
relating to the subject matterof this application and hereby authorized representatives ofthe 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 ifnot started within 180 days. Permit void if work
stops fot 180 days.
Signatuiii DATE
Do you prefer to be contacted by fax, email or phone? Circle One 1
WARNING — BUMDING PERMIT MUST BE POSTED ON CONSTRUCTIO,I SITE!
Plan fees are non-refundable and are paid in full at the time of applicatiq be' 'naiu{t�� 1. ZOOS.
City of Rezbnrg's Acceptance of the plan review fee does not constitirt: plan approval .
FAX G 9
6 y•
Nov 22 06 02:08p Myron Creager
=. lease com plete the cnAcao!
appileavle �
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's blame: ��` Business Name:
Address S 3 JI �vs?' --�9�' j City 6 &4 _State
Contact Phone: Business Phone: ( )
Email Fax - 359',
Mechanical Estimate S (Commercial/Multi Family Only)
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
_ 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
Space Heater
Unit Heater
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signalcire of tcensed Conti -actor License ;Limber Date
Required!
ne City ofRexburg's permit fee schedule is the sam as required by Ehe State,ojdaho
c
208 - 356 -3988 p.2
If the question does n®t apply fill in NA for nan
1 ..,