HomeMy WebLinkAboutAPPLICATION - 07-00316 - 179 Pioneer Rd - FireplaceFROM FAX N0. .
'i 4 '': 4. 2007 10 :37AM
Aug. 16 2003 03 : 12PM P2
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No 4481 P, 2/
CITY OF REXHURG 0700316 U E
07
ME s3QN 179 Pioneer Rd- Bradley °,p•
20�
20g- 359 - 3020 X326
n
PARCEL N1Y)VMER 6 �,� � ` ( We will provide tlds for you) C1
SUBDIVISION: - - -- _LNI'r#BLOCK #_ _ 4F ,�X
(Addmssing is based on the nafanm iea - must be scow ato) G
— CONTACT PHONE # _'� y 2-' z- 2:_
PROPERTY ADDRESS: l - 7 __ -! . J 1 _
PHONE 4: Homc ( ) Work ( ) --Cell - --
OWNER MAILL' G ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLIC'A.NT _ (If other thanes owner) _ _._�
(Applicant if other ikan owner, a statement �� uzborl&S applicant io w es agent fbr owner am= accompany this apoicnion.)
APPLICANT R4FORMATI 0N: ADDRESS CITY:
STATE, ZIP EMAIL
PHONE #: Home ( ) Work ( ) Cell
41raavO anDRESS: lb0 S � CITY��?, _s FATES i' ZIP S%
PHONE: Honk Woric# °$,3SY7 � Cc11#� /
EMAIL PAX
How tM.ny bOdings aye located on this I —
Did you recently puraim &171; propwty'?'� YCS (If - vets give owner's rte)
Is this a lot SOAVIV YES (Pleaw bring copy of new legal description of property)
PROPOSED USE:
0A, Single FaFttliy Rcddww, Multi Family, Apamnents. R=adal, Omar, Comma AttditU, ft.)
Do you pft& by fnx, email at phone? Circle One
WAJ;L"G – BURDING FEItMff jVST BE POSTED ON CONSTRUCT]ON 811V
Pis» fees are we reS mdabbe and are paid in NU at me time of appliesriov Winning & r,,.2M
City otRe burs Aereptaace of tha Pisa review he dace pat constitute plea approval
APPLICANT" S SIC- VATURE, CERTIPICATION AND AU'1'HOWI ATION: vnmer p�lq orpn I tie, ebyr � m� I tr y
read this nvbm oa and sL:Do tt d ierfos lon baneia �a�eat eed I sw�mr th�a aay an wwlaom which a,ay hsresf4v bs givan by me N hearings Whirs the pla wing
aofl Z�sg Couaazssioa ar tbo City Caimcl £or tae Csty of Ratcbag shall be e+i3a'W aed �carrecc I agree to a�eraply wig ail City rya aed Srare tav�c tetstattgto the
sa�CCt matter of his ay- y�saann sad 6 ae aaz�d z�rrsemetie�xs of ile City to ernes upon the abavamcaaowd prat;' for frdpac&w peas NOM The
b0day; off L-19 rW tavoke issued Im provisoas of the 20M hdam ujW Cod; in sass oeany Me nm nee2 armirnrpma mt WQa Q f Witt
Me Awl. -; ion o: wB ass bmt Pm h void if= mwd within 180 days. Penmen wi i£wcrk aloe for ISO "E—
5igaanuo of - -- DATE
■
OM
FAX NO
M1.7 10:3PM 0
Aug. 16 2003 03:12PM P1
0 . 'No, 4461 �- J/;
�a'r op
Building Safety Department
C1ty of Rexbur
1 9 E Main IofxAhQrexburg.oeg Phcxm : 20&359 W20 426
Rexburg IC 8340 www.rexbtxg.org Pax 208.859,3024
REXB
ew
Awrkwz FaMlly CD1=XiMW
NAME.
PROPERTY ADDRESS Pcrmitff
SUBDIVISION
.r f r r ME CIMNICAL
Mechanical. Coutmctor's Name: Business Name: � i4�.✓r`5
Address 1
l• �� � City(�cQ Stame��
Cell Phane: (2p . -_ usiness - phone:
Fax: ( � 1 / G�f� d' : _Email
Mechanical Estimate (Com aerciaUMuld Yanft fly)
FIXTURES & APPLIANCES COUNT (Single Family Dwelh g O*)
Furnace Exhaust or Vent. Ducts
F=ace/Air Conditioner Combo
How Pump
Air Gonditiancr
Evaporative Cooler
Unit Hater
Space Heater
Decorative gas -tired applim=
Incinerator System
Boiler
Dryer Vents
Range Hood Vents
Cook Stow Veins
- ...�_,.._ Bath Fan Vents
otho similar vents & ducts:
Pool Heater
Fuel Gas Pipe Outlets including stubbed m or inure ottgleU
Heat (Circle all that apply) �il Coal F'implace Electdo H
DR EC�Cflt �
JUL 13 J
CITY OF REXBURG
�r s
Date
The City of Rent 'a pa tt C xaheawe rs the same as rc fired the Slab of a/w