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HomeMy WebLinkAboutAPPLICATION - 07-00626 - 148 Kelly Johnson Way - Gas LineCITY OF REXBURG • E 0700626 MECHANICAL PERMIT APPLICATION Pleas 149 Keller Johnson Wav- Airplane H anger 19 E MAIN, REXBURG, ID. 83440 If the qi Added (Jas L ine e 208 - 359 -3020 X326 PARCEL NUMBER: � X �� -� ( We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) CONTACT PHONE # - Dpl - Ito 1 PROPERTY ADDRESS: PHONE #: Home (1v4) 3Su 7 599 Work (2oar) �_ c f - al e f Cell I - 2,10 OWNER MAILING ADDRESS: - 7" y1 5oot C CITY: a ad Cij. STATE:A!9 ZIP: 9)yy EMAIL AX __ 1.. APPLICANT (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS CITY: STATE; ZIP EMAIL FAX PHONE #: Home ( ) Work ( ) Cell ( ) CONTRACTOR MAILING ADDRESS: CITY STATE ZIP PHONE: Home# Work# Cell# EMAIL FAX now many mixtmgs 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 perjur I hereby certify that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in hearings before the Planning r and g Commissiob truthful and correct. I agree to comply with all City regulations and State laws relating to the atter of this ap the City to enter upon the above - mentioned property for inspections purposes. NOTE: The fficial may ons of the 2003 International Code in cases of any false statement or misrepresentation of fact in ation or o e plan which tl5e permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. Signature f Owner /Applicant DATE Do yo 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 1. 2005. City of Rexburg's Acceptance of the plan review fee does not constitute plan approval