HomeMy WebLinkAboutAPPLICATION FORM - 06-00235 - Cook Office SpaceREX$ Ult
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DATE:
City of Rexburg TO:
P.O. Box 280
19 East Main
Rexburg, Idaho 83440
Phone: (208) 359-3020
FAX: (208) 359-3024
NAME:
COMPANY:
FAX NUMBER:
PHONE NUMBER:
FROM:
NAME: JANELL HANSEN
PHONE NUMBER: x 326
FAX TRANSMITTAL FORM
PAGE I OF
Please forward this fax transmittal to the above named individual.
P. 1
Memory TX Result Report ( Oct.23. 20011:56AM)
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Date/Time: Oct.23. 2006 11:55AM
File Page
No. Mode Destination Pg(s) Result Not Sent
----------------------------------------------------------------------------------------------------
2946 Memory TX Rocky Mtn Power P. 2 OK
----------------------------------------------------------------------------------------------------
Reason for error
E. 1) Hang up or line fail E.2) Busy
E. 3) No answer E. 4) No fats imi 1 e connection
E. 5) Exceeded max. E—ma i 1 size
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CITY OF
REXBURG
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Americas Family Community
BUILDING SAFETY DEPARTMENT
19 E. Main St Phone: 208-359-3020 x326
Rexburg Idaho 83440 Fax: 208-359-3024
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APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
APPROVED BY:
-APPLICANT INFORMATION:
BUSINESS NAME:
OFFICE ADDRESS:
City
State
OFFICE PHONE NUMBER: ( )
CONTACT PERSON: CELL PHONE #
-LOCATION OF WORK TO BE DONE:
STREET ADDRESS WHERE WORK WILL BE DONE:
BUSINESS NAME WHERE WORK WILL BE DONE: _
DATES FOR WORK TO BE DONE:
CONTACT PERSON:
PHONE NUMBER: ( 1 CELL #
PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR:
❑ AUTOMATIC FIRE -EXTINGUISHING SYSTEMS
Zip
❑ COMPRESSED GASES
❑ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT
❑ FIRE PUMPS AND RELATED EQUIPMENT
❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS
❑ HAZARDOUS MATERIALS
❑ INDUSTRIAL OVENS
❑ LP -GAS
❑ PRIVATE FIRE HYDRANTS
❑ SPRAYING OR DIPPING
❑ STANDPIPE SYSTEMS
❑ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES
APPLICANTS SIGNATURE DATE
...........................................................................................
6
SUBCONTRACTOR LIST
Excavation & Earthwork: L Aeteq JCS -,S
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other: