HomeMy WebLinkAboutAPPLICATION - 07-00468 - 2511 N 6000 W - Fireplace:p 21 07 02:05p Myron Creager 208 -356 -3988 p,1
�ITY OF REXB URG •
BUILDING PERMIT APPLICATION Ple a S i 0 70 04 6 8 11
19 E MAIN, REXBURG, M. 83440 If the qi 2511 N 6000 W Harris 'le
208- 359 -3020 X322
PARCEL NUMBER: �'��(, ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
c 1 H, f'/, �y
CONTACT PHONE # mss' /
PROPERTY ADDRESS: 26 // N. 600 Gtr
PHONE #: Home ( ) Work( ) Cell ( )
OWNER MAILING ADDRESS: CITY: &k STATE & ZIP ; qY 6
EMAIL
FAX
APPLICANT (If other than owner) C'� s �.,,•� .�. ��� �r
(Applicant if other than owner, a statement authorizing applicant togas agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; -�Z ZIP (T r - //-/V EMAIL FAX
PHONE #: Home (
Work ( ) 30-3Vv Cell ( )
CONTRACTOR
MAILING ADDRESS
PHONE: Home#
EMAIL
.%. — Off[ T Lr` -
�?- CITY �,c .% T STATE -- ZIP S/o
Work# J 5 �' —wig Cell#
FAX 3.5� 3f 8' e
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 penalt of perjury, I hereby certif that l
have read this application and state that the information herein is correct and I swear that any information which may hereafkx be given by me in hearings before the
Planning and Zoning Commission or the City Council for the City of Rexburg sbali 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 f 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 if work
stops for 180 d
/ / 07
Signature of Owner/AV—pt—cant 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 beginuffig lasuary 1.2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval . .
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Sep 21 07 02:05p Myron Creager 208 - 356 -3988 p,2
Please complete the entiir�A Iication i If the question does , apply fill in N4 for �� 9 gp v . fo nor
applicable
NAME
PROPERTY ADDRESS S !! B -fJ�j _ Permit#
SUBDIVISION
Required!!!
MECHANICAL
Mechanical Contractor's Name: << ✓ Business Name:
ti
Address T-5 3 ' T9'D�( City S
tatel Zip
Contact Phone: ( ) Business Phone:
Email Fax 3�s6 - 3 , 9 9 y8-
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
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 Plans & Application
Point of Delivery must be shown on plans.
5' - 2/, c 7
Signature o' -jcensed Contactor License nun;ber Date
Required!
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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