HomeMy WebLinkAboutAPPLICATION - 08-00143 - 357 W 4th S - DemolitionBuilding Safety Department
City of Rexburg
19 E. Main jonellh@rexburg.org Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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C I T Y O F
REXBURG
Americas Family C:ammunity
Application for Demolition � I
Permit #: O
$25.00 Fee Paid Yes/ o Permit Approved: Yes /No
Applicant Informati
Name: ktz.it�.�.i
Applicant's Address: i ?' Q City /ST /Zip: : - x'lpr j ,� r) F1 440
Business Phone: a- 7, Z'Z — <•I S"0 O Cell Phone: 2-0 U
Contact Information
Person or Company doing the demolition: 6b Lac._ (
Address: 1 hi - 2 . cJ City /ST /Zip: tG T3 ( A O
Business Phone: .2a ^ 2.'L?— q 5`Ze Cell Phone: '2V'T ` -- of 5
Demolition Information
Property Owners: =f_'n - T /. Lam_ 4, a 4
Site Address: • � S 7 60 -<s �'�' Y arr4
Start Date: Ae"' J / 266 Completion Date: 4� ^� I /d 200 r
Summary of what is being demolished: t n q �r PA M , k-J tJc c� ��,� d\q I
The U.S. Environmental Protection Agency (EPA) regulates the abatement and disposal of asbestos -
containing materials from any public or private building involving demolition, renovation, repair,
construction, and maintenance activities. httg: / /deq.idaho.gov /air /grog issues /pollutants /asbestos.cfm
EPA certifies and licenses asbestos - removal contractors, inspects asbestos - abatement projects, and enforces
laws regarding the proper removal and disposal of asbestos - containing materials.
Currently, EPA and DEQ contract with Industrial Hygiene Resources in Garden City, Idaho, to regulate
asbestos removal and disposal projects in Idaho.
For more information about asbestos abatement and disposal in Idaho, contact:
Industrial Hygiene Resource
206 Murray St
CTard, -n City TTY R3714
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Building Safety Department � C ITY OF
City of Rexburg cr � r � T i
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19 E. Main ionellh@rexburg.org Phone: 208.359.3020 ext 326 Americas Family Community
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
Affidavit of Legal Interest
State of Idaho
County of Madison
Name
City
Being first duly sworn upon oath, depose and say:
3�s 7
Address
State
(If Applicant is also Owner of Record, skip to B)
A. That I am the record owner of the property described on the attached, and I ant my
permission to: sL�,4 � D L a i 34 AI r w !n, 31-2 Pxv-/ (
Name Address
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulting from any dispute as to the statements contained herin or as to the
ownership of the property which is the subject of the application.
Dated this �[ /! e - day of , 20 eP
Subscribed and sworn to before me the day and year first above written.
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Residing at: `
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My commission expires: 0 - 16" l