HomeMy WebLinkAboutAPPLICATION - 07-00577 - 3055 W 1000 N - FireplaceCreager
OF REXB URG 0
PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 -359 -3020 X322
PERMIT # •
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If the qla 0700577
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P ARCE LNUMBER: 1U C.� , ( 3055 W 1000 N- Hampton
SUBDIVISION: U
(Addressing is based on the information - must be accurate)
CONTACT PHONE # 3S ,6 -- S:5 - - -2-
PROPERTY ADDRESS: 3C%5'5 Gj/ /P00 N,
PHONE #: Home Work (
OWNER MAILING ADDRESS: sue... -.r
EMAIL FAX
APPLICANT (If other than owner) CeiT i E,,,, � F-
(Applicant if other than owner, a statement authorizing applicant to acf as
for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS ` � g /��wT�•t � e)/ CITY: ���� -�✓�
STATE; ZIP K 'fyu EMAIL FAX �5G' _ 9
PHONE #: Home ( ) Work( ) 7; 5 4�'OaS'' Cell( )
CONTRACTOR _C �, o• • — �lr i; %cpL _
MAILING ADDRESS: b's 5 S / /u•�� / CITY — STATE — l�
PHONE: Home# Work# 5 � Cell#
EMAIL FAX
rauvv uiaray vuiium are tocaTea on ruts propeMt
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 certify that 1
have read this application mad state ibat the iaCarmation herein is coned and t swear that any information which may hereafter be given by mein hearings before the
Planning and Zoning Comrnissian or the City Council for the City of Rexburg shall be truthful and correct. I agree to eorn y with all City regulations and State laws
relating to the subject nuaw of this application and hereby audwriaed representatives of the City to enter upon the above - mentioned property for inspections purposes.
NOTE: The building official may revoke a permit are approval issued under the provisions ofthe 2000 International Code in cases of any false statement or
misrepresentation of fact in the application or on the plans on whicbft permit or approval was based. Permit void if not started within 180 days. Permit void ifwork
stops for 180 oyr_ I
Signature of Owner /cant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SM!
Plan fees are non- refundable and are paid in full at the time of application ibeginning 2001
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval - .
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CITY: �L_,- STATE: " ZIP: 5 ter
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U, UIJ.4up myron ureager 208 -356 -3988
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PROPERTY AD DRE�
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SUBDIVISION
Permit#
MECILIrICAL
Mechanical Contractor's Name: C , I s
Business Name:
Address �S 7 S, ��lv.✓ �c� -:4t q p
Cit Stat Zi
Contact Phone: ( Business Phone:
Email
Fax .3 5'G
Mechanical Estimate S (Commercial Multi Family Only)
FIXTURES & APPLL"CES 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) (G�a 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.
Sia1laEure Licensed Contractor License number
Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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