HomeMy WebLinkAboutAPPLICATION - 07-00005 - 60 K St - FireplaceCITY OP REXB URG PERMIT 4 41
BUILDING PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REX13URG, ID. 83440 If the question do - - - -' - - - ° -- r„ -- n,. r__ _ _-_ _-_ •_ -„-
208- 359 -3020 X322
PARCEL NUMBER �Q la. ( We will 0700005
S UNIT# 60 K St - Mechanical
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS: u G e2 i .
PHONE #: Home (2vr) 3�p - Y�or- Work (
Cell (
OWNER MAILING ADDRESS: __ n 4 . 5 Z CITY: , l STATE:,T) _ZIP :
EMAIL FAX
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 FAX
PHONE #: Home ( ) Work ( ) ( )
CONTRACTOR
MAILING ADDRESS: 6l 6 l� SP Y CITY , F STATE i 0 ZIP Jr �
PHONE: Home#
EMAIL
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M-l".
Cell #
How many buildings are located on this properly? 1
Did you recently purchase this property? &V Yes (If yes give owner's name) - /i/,,
Is this a lot split? 10 YES (Please bring copy of new legal description of property)
PROPOSED USE. �; - le. 1 - 4
(i.e-, Single Family Residence, Mu ti Family,
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of penur I hereb certif that l
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 Stale laws
relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above- mentioned property for inspec tions purposes.
NOTE: The banding 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 if not started within 180 days. Permit void if work
stops 180 days_
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Sagntiture ofOwnerlApplicani
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Do-you prefer to be contacted by fax, email oCEkoney Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUM- SITE:
Plan fees are non - refundable and are paid in full at the time of applicatign beg snnig�Jvnu 1 2005.
City of Rexbotg's Acceptance of the plan review fee does not codstittiitj plan a
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NAME
PROPERTY ADDRESS ' G S . 1� y . Permit#
SUBDIVISION
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MECHANICAL
Mechanical Contractor's Name: E Gt• '� ��cG� e �X Business Name: (
Addres
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Contact Phone: (2-Y) 3 sy Business Phone:
Email Fax 3 S6 3
Mechanical Estimate S (Commercial/Multi Family Only)
FIXTURES & 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
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 EIectric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Si - nature of icensed Contimctor License number Date
Required!
The City of Rexburg's permit fee schedule is the same as required by the State, ofldaho
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