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Home My WebLink AboutAPPLICATION - 07-00400 - 4413 Juniper Ave - Fireplaceg 23 07 12:51 p Myron Creager ;ITY Off' REXB URG 0 r3UILDING PERMIT APPLICATION 19 E MAIN, REXBURG ID. 83440 208 - 359 -3020 X322 208- P 0 Pleas4 0700400 1! If the qt 4413 Juniper Ave -Cnty Mech )ie PARCEL NUMBER: I Cn �1 (=�.'l CA ( we will provide this for you) SUBDIVISION: UNIT# BLOCK #_ (Addressing is based on the information - must be accurate) LOT# L CONTACT PHONE PROPERTY ADDRESS: PHONE #: Home ( ) n Work ( ) Cell ( ) OWNER MAILING ADDRESS: S h` /n CITY: K�' STATE: �� EMAIL FAX APPLICANT (If other than owner) e- -i , En- - (Applicant if other than owner, a statement authorizing applicant to act as agenf for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS °� y! CITY: ZIP f _ EMAIL FAX 556. F'g PHONE #: Home ( Work ( Cell ( ) CONTRACTOR MAILING ADDRESS: t s' l�vw,. �` CITY PHONE: Home# Work# Cell# EMAIL FAX 3 S ' 3 How many buildings are located on tilts 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 f)Pf1C T T4F (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 1 have read this application and state that the information herein is correct and l 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 truthftd 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 Has based. Permit void if not started within 180 days. Permit void ifwork stops for 180 days. Signature of Owner / App 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 in full at the time of application beginning January ]. 2005. City of Rexburg's Acceptance of the plan review fee does not constitute plan approval - 3 STATE <-. D r!` _ef Aug 23 07 12:51 p Myron Creager Fl se 'Lon &Yv E'p.te the NAME PROPERTY ADDRV-SS i A-, SUBDIVISION Permit# Requiredffl MECHANICAL Mechanical Contractor's Name: Business Name: ;� -�---5 6C h Address &S' 9 �r City State Zi f 1111b Contact Phone: ( Email Business Phone: ( ) 357�- Fax 3 - Y,9r d Mechanical Estimate S (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 _L Fuel (gas) piping fixtures or appliance outlets Furnace Furnace /Air Conditioner Combo Heat Pump Incinerator Pool Heater Heat (Circle all that apply) Oil Coal Fireplace Electric Space Heater Unit Heater Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Sianatare of icensed Contractor License number 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 If five gpaesti doeso apply it ;! jut NA for non 5