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Home My WebLink AboutAPPLICATION - 07-00321 - 327 S 3000 E - Fireplacei l 16 07 12:46p Myron Creager ITY UILDR4G PERMIT APPLICATION 208 -356 -3988 Pr_n1k .rr1r u 0 Please e® 19 E MAIN, REXBURG, SID. 83440 If the questic 208 - 359 - 3020 X322;... .� 1 PARCEL NUMBER: f 1 (P �I 3 J q U (W e SUBDIVISION: UNIT# (Addressing is based on the information - must be accurate) P.1 0700321 327 S 3000 E- Fireplace BLOCK# LOT# lzl_ CONTACT PHONE # S/- 8 ? PROPERTY ADDRESS. 3- 0 � - - s v PHONE #: Home (��Y) 356 - � Work ( ) Cell ( ) OWNER MAILING ADDRESS: CITY: ��C J STATE: � S IP 5d" 7fV a — EMAIL FAX APPLICANT (If other than owner) C ,,, T, . f (Applicant if other than owner, a statement authorizing applicant to act as agent for owner most accompany this application.) APPLICANT INFORMATION: ADDRESS r J' 7'p oar %•� g�' CITY: 12q,4-" n STATE; ZIP 9'3 y y EMAIL PHONE #: Home ( Work (�� 35 � Cell ( CONTRACTOR C r-- C r MAILING ADDRESS: (�'`� S S= r '�Pd / CITY PHONE: Home# Work # ZA9 3 SS EMAIL FAX 7C' S6- 3 / M STATE W- ZIP 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) PR 0P(1CRT) T TRR- (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under penalty of perjury, I hereby certify that I have read this application and state that the information herein is correct and [ swear that any information which Wray hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and coned [ agree to comply with all City regulations and State laws relating to the subject matter ofthis 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 rases of any false statement or misrepresentation of fact in the a on or on the pans o which the permit or approval was based. Permit void if not started within 180 days. Permit void if work slops for 180 days. Signature of Owner /Applicant DATE Do you prefer to be contacted by fax, email or phone? Circle One WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! Plan fees are non - refundable and are paid is full at the time of application beginning January ). 2005 City of Rexburg's Acceptance of the plan review fee does not constitute plan approval FAX 3 Jul 16 07 12:46p Myron Creager P lease. ase. Ccunpiede fi -'antnVA phe Lion! 2 "oplie:tly._ NAME 1 PROPERTY ADDRESS SUBDIVISION Permit# Required t l MECHANICAL Mechanical Contractor's Name: Business Name: Address fs > � /�� -- � 0/ City �-- State Contact Phone: (Wop) S� $Gig' Business Phone: ( ) Email Fax Mechanical Estimate S (Commercial/Multi Family Only) FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only) Air Conditioner Space Heater 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) WOil Coal Fireplace Electric Unit Heater Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Signature of Lic nsed Contractor License number I Date Required! The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 208 - 356 -3988 p.2 0 If the question does -,not axtnl`r fill b N4, iiot ,2 oi- is:l -.3i3,�,