HomeMy WebLinkAboutAPPLICATION - 06-00091 - 339 S Pine Ave - Fireplace- CITY OF., REXB URG '1
BUILDING PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
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SUBDIVISIQN: UNIT# BLOCK#
(Addressing is based on the information - must be accurate)
W I Nei a 404 Iff. aL/AG
PROPERTY ADDRESS:
CONTACT PHONE #
PHONE#: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY:
EMAIL
FAX
LOT#
STATE: ZIP:
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
STATE: � r.� ZIP EMAIL
PHONE #: Home ( Work
CONTRACTOR: qovp;o-
MAILING
ADDRESS:
PHONE: Home#
EMAIL
A&I-3"iikie
�,4NIt, hsalc. � CITY
Work# Cell:4
FAX
L
�rU fl CITY:
Cell
STATE
ZIP
How many buildings are located on this property.` ^---�-�=•�-�PL EM SFDid you recentl urchase this roerty`� No Yes If �s ive avvner's name
Is ��is a dot split? NO YES �Pleas� bring copy of new legal description of properlyl FEB 2 3 Z006
PROPOSED USE
i.e., Single Family Residence, Multi Fainily,.Aparttnents, Remodel, Garage, Commercial, Addition, Et LAI_
APPLICANT' S SIGNATURE, CERTIFICATION Under r penalty of perjury, I hereby certl'f
that I have read this application and state that the inform .ti n herein is correct and l swear that any information which may hereafter be glean b m
in hearings before the Planning and Zoning Commission or the CIty Council for the Cite of Rexburg shall be truthful and correct{ l agree to comply
with all Citv regulations and State laws relating to the suject ratter of this apptication and hereby allth ri d representatives of the it T to enter
upon the above-mentioned property for'inspections pa . NOTE: The bu11 l'n official may revoke a n ift on approval issued under the
provisions f the 2000 h t coati n l Code in cases of any false statement or misrepresentation of fact n. the applicatioii or on the plans on which the
permit or approval was based. Permit void if not started within ISO days. Permit void 'if work steps for 180 days.
1 nt r f Owner/Applicant DATE
Do you prefeir to be contacted by fax, email or phone? Circle One
WAKING — BUILDING ERMIT MUST BE POSTED ON CONSTRUCTION SIS'
Plan fees are non-refundable and r paid iapplication
u Full t the time f b inni
.n _ 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
"Building Permit Fees are due at time of ppli t "Building Perm its are void if you check does not clear*
`Please coMp"fi7reeine nire
A
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Requited!!!
Mechanical Contractor's Dame;
Address i10.
Contact Phone-. (
Email.
r
_�
pplicat1011If the question dEwe
oes not apply fillin NA for non
MECHANICAL
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Mechanical Estimate S
Lqa -- 1-i ? 7 G
Permit#
Av,e qAe 0 Business Name:
city_5uele •, - State 1 �J/ Zip
Business Phone: ( )
Fax
(Commercial/Multi Family Only)
FIXTURES & APPLL4-NCES COUNT (Single Family Dwelling Only)
Furnace j � Exhaust or Vent Ducts
Fumace./Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
1 � Decorative gas-fired appliance
Incinerator System
Bailer
Pool Heater
Simi*lar fixtures or Appliances
3x
Fuel Gas Pips Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) has 0*11 Coal Fireplace Electric
Dryer Vents
Range Hood Venin
Cook Stove Venin
Bath Fan Vents
other similar vents & ducts:
FA
Mechanical Sizing Calculations must be submitted with. Plans & application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
U.C-ense number
Date
The City of RexbuYg's permit fey schedule is the same as required by the State of Idaho