HomeMy WebLinkAboutAPPLICATION - 07-00319 - 554 Maple St - Fireplace07/18/2007 10:30 2085234638
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CITY OF REXBURG
WCHANICAL PERMIT APPLICATION Plea:
19 E MAIN, REXBURG, ID. 83440 H the c
208. 359 -3020 X326
0700319
554 Maple -Baker
PARCEL NUMBER � � ,� We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the infonwition - must be acem -, te)
Q '11t FR: ` k� M CONTACT PHONE #
PROPERTY ADDRESS �'1 b/ -�OL� _ '9 . 2
PHONE #: Home Q .Work ( ) Cell ( )
OWNER MAILING ADDRESS . n STATEa&ZIP: jL-�L0"
EMAIL FAX
�JPPLIGANfi (If other than owner)
(Applicant if other than owner, a Grate mt authorizing applicant to act as agent for owner omit accompany this application.)
APPLICANT INFORMATION; ADDRESS CITY:
STATE; Z1? EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTQR
MAILING ADDRESS �JJ 62,U.),0 XU?A -a TY ,� A4A ZIP_
PHONE: 14=0 Work# 3 Cell# & I3 �� � - �'�{luJ.
EMAIL FAX
than Imildinve arP In(-a +rri nn fine nrnnorlv9
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 properly)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Gmno, Coalmercial, Addition, Ntc.)
APPLICANT'S SKINATUPM CERTIFICATION AND AUTHORIZATION.- U nder penalty of perjury, I hereby wtirly that I have
toad Ihia opplicaVon and crate that the imf m:njen herein is correct sad I swcia 69 XW infomte t which mq h 1 8 F be ffim byme is hoari p before the haooing
and Zoning Comrmiosion ordw Chy Cowrcil for the City of Pmburg %ball be Itothtlrl and coated lag= ro oomapi'br with ail Chy regnlnUM and Stow lawn reletimg to !be
Object l ofthb appliradoo and hereby m tbarind reprnmmdves orrbe CI[Y tlo enter upom the exm m doocd paparty for bnpeodoas ptinpau& NOTE: The
buitdipg ofcW mr i revoke a perm* oo approval kwed under tba provisions ofiha = Ilnlanifienal Coda is ceics of mW iMse stt%emmt ar mkepmettation of tbd in
the application or on the plans on which the permit or approval W93 based Permit void Umot %tatted ►Rata 181) days. PaIndt void t£wotk swps for 180 days.
Signature of Owner /Applicant DATJE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — lWaMING PERMIT MUST BE POSTED ON CONSTRUCTION Srn,
Plat, fees are now- refundable and are paid to full at the time of application beginning LqgN axLZ ' &V&
City of Rezbm gla Acceptance of the plan review fan does not eanstitate plan approval
LEISURE TIME INC PAGE 02/02
No. 3539 P. 2
07/18/2007 10:30 2085234638
jai. IC. Mt IU:14AM I *
LEISURE TIME INC
Building Safety Department
CRY of Rexburg
19 E M014 Iawmam iftmorg Phone: 208.939.E X326
Rexbu%% 0 83440 www.mxbwq.gV FCW A"W.3.5 -W4
PAGE 01/02
No. 3539 P. 3
CI OF
RM
'• '•.eO •• AngrlQabF�ilyCbmmnnlry
SUBDIVISION
Permit#
.Requiredlll MECI LAICAL
Meebsnical Contmctor's Name ll Businms Name; I to 5 U,1DL 4I j y_j,J- -
Address
Coll Phone: 7k5 3 /3-; Businea9Phone:
Fax: (ion q -3 - Email -
Mechanical Estboate $ (Commercial/Multi Fan* Oink)
FXXTURES A APPMNCP.S' COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator Systems
Boiler
Pool Heater
Dryer Veers
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Fuel Cm Pipe Outlets including stubbed in or future outlets
Heat (Circle all that appt�.Oil• Coal Fireplace Electric Hydronic
Mee an c 1 MAR C$Jcuia- is mnst be submitted Pbins & Apuh,�cadon
Point of Deljy= must beshowaat on plans.
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