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www.rexburg.org
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REXBURG
C\''*-*-
Amaica! L'anrily Ctnn nuflity
35N l,rE
Rexburg, lD 83440
Emergency Services
Phone: 208.372.2326
Fox: 208.359.3022
$5O.OO FEE P
PERMTT *: / Z rtO/(a I
/NO PERMIT APPROVED: YES/NO
BYI ATE: y'- r1'l'Z-
OrvnerMailing tlaaress, /?ct Lro 2d i1ap-'nt
ProperrvAd ar"rr, (-bS - 'za pt [n,<rrf Ce]l/offrce Number:
nt!Business Name Where Work V/ill B"Don
OfficeAcldress: /- " cru 2d /tt,,',""f'/-.--* -
Office Phone Nurnber: Contact person: A_L!4 Contacr phone g.'F€r} -% 3 |
Applicant Information:
..OPERATIONAL PE RMIT'' APPLICATION
Name:
Name of Bus
B.* ,-.>a'l'-L-(s
Address:
Contact Person:
">&LJ N)
PHONE Nuiusen, vb_€ gt1_cELL #
Pande Route / AssemblyLocation:
(Map rcquircd fot Pandis)
//4/ r r/zc,ra
Datb
PLEASE CHECKTHE TYPE OF PERMIT(S} YOU ARE APPLYING FOR:
= Aerosol product manufacturing
List of contents:
n Combustibledust-producing operations
Location:
Tvpe of dust:
: Coveredmallbuildings
Location:
I Cryogenic fluids
Types:
= Cuning and welding operations
Location:
: Dry Cleaning plants
Location:
Types of Chemicals:
n Exhibits and trade shows
Location:
Type of Fire Extinguishers & Location:
4 Explosives
lo.u-,i5nl"'"ro4;'A" uid* 5 tI [a2",r
Types: 2, cx- ( ( ( g ,- 72-u*.- /okz
: Fire hydrants and valves
Locations:
Types:
: Flammable and combustible liquids
Types:
-l Floor finishing
Types:
= Fruit and crop ripening
Locations:
Types:
L: Fumigation and thermal insecticidal
fogging
Locations:
Types:
n Hazardous materials
Locations:
Types:
= High-piled storage
Location:
Contents:
tr Hot work operations
Location:
Dates & Times of Operation:
: HPM facilities
Location:
I lndustrialovens
Location:
Types:
= Large capacity battery systems
Location:
Tvpe:
= Liquidlgas vehicleslequip. in assembly
buildings
Location:
Tvpe:
- LP gas transportation
Location:
Tvpe:
I Lumber yards/plants
Location:
: Magnesium work
Location:
I Misc. combustible storage
Location:
Type:
= Open burning
Location:
Time & Date:
= Operating amusement buildings
Location:
= Operating aviation facilities
Location:
= Operating carnivals or fairs
Location:
Dates & Times:
: Organic coatings
Tvpes:
n Places of assembly
Location:
Dates & Times:
I Private fire hydrants
Location:
n Pyroxylin plastics
Types:
n Refrigeration equipment
Types:
! Repair garages/motor fuel dispensing
Location:
n Rooftop heliports
Location:
n Spraying or dipping
Location:
n Storage of combustible fibers
Location:
lJpqs:
n Storage of scrap tiresletc.
Location:
I Temp. membrane structures, tents, and
canopies
Location:
Date & Times:
n Tire-rebuilding plants
Location:
f, Use/Storage of compressed gases
Location:
Tvpes:
I Waste handling
Types:
n Wood products
Tvpes:
Additional lnformation:
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;:?:i::f In "",,,. ""lve,opment
35 North '1st East / Rexburg, lD. 83440
Phone (208) 359-3020 / Fax (208) 359-3022
Receipt Number:
12 00168 RPR00CC002 Base Fire Fee
APR I | 2012
CITY OF REXBURG
genpmtrreceipts
Page 1 of 1
Xfress Bill Pay - Payment Profsine
Billing Information
DEWEY D SMUIN
.83440
Page I of I
City of Rexburg
35 Northlst East
Rexburg, lD 83440
208-359-3020
4Ct tlcl, Prir
Total Paid: I SS0.OO
ei
I Transaction detail for payment to City of Rexburg.Date:0411112012 - 10:18:56 AM
Transaction Number; 14930828PT
Mastercard - XXXX-XXXX-XXXX-501 1
Status: Successful
Description Reference #Amt per ltem f ltems Iotal Amt
BUILDING PERMIT 12 00168 $50.00 1 s50.aa
Notes: permit for blasting
Transaction taken by: marianna
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https ://www.xpressbillpay.com/common/paymentjrocess.php 4lrv20r2