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Home My WebLink AboutAPPLICATION - 07-00153 - 305 E 3rd S - Fireplacer r 06 07 11:40a Myroh Creager CITY OF REXB URG BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208- 359 -3020 X322 208- 356 -3988 p.1 Please If the qule& PARCEL NUMBER: f U � b�T b ( R SUBDIVISION: UNIT #_ (Addressing is based on the information - must be accurate) 0 0700153 305 E 3rd S- Twitchell BLOCK# LOT# OWNER: /If / CONTACT PHONE # 3 S'G 3 PROPERTY ADDRESS: PHONE #: Home .4? 4Y' Work Ot4 �fk- 32 Cell ( ) OWNER MAILING ADDRESS: )D9-N-- CITY: R,11,,23 STATE : ZIP , 633W EMAIL F AP,PL�CANT (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 g$�J �• ��s � ` �D/ CITY: 4 -1AI _ o. STATE; — ZIP / Y U EMAIL PHONE #: Home ( ) Cell ( CONTRACTOR , MAILING ADDRESS: CITY oLP,�C 1�, STATE ZIP PHONE: Home# Work# 337- -WD Cell# EMAIL AX 756 - V 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 of perjury, I hereb certif 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 - 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 if not started within 180 days. Permit void ifwork stops for 180 days. Signature of Owner /Applicant DATE Do you prefer to be contacted by fax, email or phone? Circle One WARNING — BUILDING PERAW MUST BE POSTED ON C0NSTRVCT10JI SITE! . Plan fees are non - refundable and are paid in full at the time of application beginniAS lizauary 42005. City of Rezbarg's Acceptance of the plan review fee does not constitute plan approval . . 3 FAX I Apr 06 07 11'40a Myroh Creager 208- 356 =3988 p.2 ' � O"t f o a _ t,t✓ :aft �r_ 1llt per :wn_ alrPIiC able t NAME - 7 . a,T /.1// PROPERTY ADDRESS 506 Permit# SUBDIVISION MECHANICAL Mechanical Contractor's Name: Business Name: C - -F& , - Address 4S 9 S, `f %arvrT6r .11: / City &d3 - •--� State SID , Zip W� rd Contact Phone: (�� <SS'— �C-`� Business Phone: ( ) Email Fax - 3 SG Mechanical Estimate (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 PIans & Application Point of Delivery must be shown on plans. Si_nature of Licensed Contractor License number Date The City ofRexburg's permit fee schedule is the some as required by the State. of Idaho 6-'