HomeMy WebLinkAboutAPPLICATION - 06-00065 - 517 Linden Ave - Fireplacei ml -
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CITY OFREXBURG
BUIk DING PERMIT APPLICATION
19 E MAIN., REXBURG, ID., 8.3440
208-359-3020 X322
PARCEL NUMBER
SUBDFVISION:
(Addressing is used on the information -mush be accurate)
P
4
entire
If he a Ueq
6
.I
517 Linden Ave -Mechanical
OWNER: 0 r. Wo j�; CONTACT PI30NE 9 � S 9— 96,F�
PTt01'ERTYADDRESS: 5- 7 'L j jAi, �. _eWA,." �Q.,,_.�
PHONE #� Home Work ( ) Ceil
''� OWNER MAILING ADDRESS* �o •--�
CFTY: I�x b�'S
EMAIL
FAX
STATE:57D"W6
AJPP.LIC.A.2VT-. (If other than ovvner) C4 -,s -f - �.s c� � � �-� ,�'. � -*• r
(Applicant ifotber than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION:
ADDRESS or `/����v=i�.--
'got/ CITY: or,
� ��p
STATE.,. EMAIL FAX -1`5Z, 3%�'�
PHONE#:Home(Cell(
CONTRACTOR:
MAILING ADDRESS: `�'� 9 J - xc//�,�-�`,� �vt
CITY rL ur.�,.<,�5
PHONE: Home#
Work# Cell#
STATE �QZIP
EMALL FAX 11:5- a.9 371"
How many buildin�s are loc-mated, oprone1_Did you recently purchase this uro erty. Nv9 yes
(If yes give owner's name)
Is this a lot split?. NO YES (Please bring copy of new legal descriptian of property)
PROPOSED USE:
0.e.1 Single Family Residence, -AL4ultj Family, Apartments, Remodel', Garage, Commerei'al, Addition,,
....... .......
APPLICANT'S SIGMATURE:11, CERTWICATIO
er P I hereby certi
Gf MU
N A] TE �UTH 1UZ TI N
b nv e ma d this V P1 =t'o n =d s 1�n tc, oat tbe _nfotmation hcmin is corr=t and I swear that any in I � M h
Or dhe City of Rexburg shall be b-uthEd and c rrect- I a
,nd Zcm iv. City Council f foFmation wh-ch hercaftLTb� C*3
i
Planning V Ing corn ralss icr, orb UY WOT
0 'grce to cornply w I City reffU
re I 2J ng IG the Is ubje c t tn attet o fth I s aDp 11 c:at] a n and h e reby auth 0 1i z -rd re p r=n tativesC' I a6ans and Stat
N 0TE_- -1-hr. b U -11 C1 ing luffl cia I may re IIII k- e a pertni t on app T-ov a( - AY to ffnIer upon the above -menti ad propcM for inspectioyLs, pu"-s"Cls-
1 s sucd und cr the pro vi si ons of th c 2000 In III ern:a tional Curie iucas an
M I:Srcp res untatic n o f fact En the app j 1.rat ion 0 r on e p] an Is c n wh ch the pe rM i of approval -I y fWse slatement o;r
Is based, Permit void if ncpt starte Ork ji�i, I
"I J
stops for ISO days,
S
19 -nature 4e
of Own licant DATE
DO You Prefer to be coiitacted by fax, email or phone? Circle One
WARN -TING — 1L7ffiDG PERMIT MUST BE POSTED ON CONTRUCTIoN SITET
Plan fees a re non-rie fan da ble a n are Paid in full A It theti We of application beginn iva januM 0
JI J? 2005.
City of Rex:burg"s Acceptance of the phn review fee does not coitstitutc plan approval .
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A al . apply fM i n. fAli-,N1. for 3ws,
PROPERTY ADDRESS *j/ � t_ ,«. � ,,, ��
STJBDIVISION
Mechanical Cantractor's Name: 4 �.
-&4-21—
Address ��� .�"���a�,..�.�.� ��'�'r
City
A�u
P erini w
Business Name:
Contact Phone: (J� elf ) $usiness Phone: ( �
Email
'Fax � � �n � �� ;�
Mechanical Estimate $ (CommerciaUMulfi Family Only)
FIXTURES &APPLIANCES COUNT (Single Family Dwelling Only)
Air Conditioner
Bath Fan Vents
Range Hood Vents
Boiler
Cook Stove Vents
,�� Decorative Gas Fireplaces
Dr5Fer Vents
Evaporative Cooler
Exhaust or vent duGXs
duel (gas) piping fixtures or a I -
pp ance outlets
Fumace
Fumace/Air Conditioner Combo
Heat Pump
Incinerator
Pool Heater
Heat (Circle all that apply)oGas,�-'Oml Coal Fireplace Electric
State 7i, ,��'%/ri
9 ME%
Space Header
Unit Heater
MeChaniCal Sizing Calculations
must be submi
'Otted with Plans & Application
` � ������ P�� t of Delivery must be shown on plans,
-S i L f
0 1k I L r M4; to F
0
Licenso IlUmber
Date
The City of Raxhurg "-
P erm it fee schedule is Me same as required by the State ofidahG
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88E£ -99E -80Z
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