HomeMy WebLinkAboutAPPLICATION - 06-00052 - 858 S 5000 W - FireplaceMyron Creager
CITY OF REXB URG •
208-356-3988 p.1
PERMIT # •
BUILDING PERMIT APPLICATION Please complete the entire Application!
19 E AMAIN, REXBURG, ID. 83440 If the question does not apply fill in \TA for non applicable
208-359-3020 X322 q'
PARCEL NUMBER: K~~~~ ~ 1~,~`~[ ~;e O6 OOOSZ
SUBDIVISION: UNITt
(Addressing is based on the information -must be accurate)
858SS000W
Edstroln-Mechanical
OWNER: (/...-~.,. F,ti r a ,~~,...~ CONTACT PHONE #
PROPERTY ADDRESS: S"s~` S • S oo ~ ~.~ .
PHONE #: Home (1~~ s SG- ~3.~-8' ~'" Work
OWNER MAILING ADDRESS: -s -s -~--r
EMAIL
FAX
Cell
CITY: ~~~~^~~ STATE: ~-d-ZIP: ~3~/~'u
APPLICANT (If other than owner) ~~~Ta„_, ~~-,r;,` F-.--,,fl_ --,T
(Applicant if other than owner; a statement authortztng applicant to act as agent for ovmer must accompany this application.)
APPLICANT INFORMATION:
STATE; •~~ ZIP S~'3 ~/%~~ EMAIL
PHONE #: Home
ADDRESS 53~,~5-,~~~~-'NKr~`L•'~'ITY: ~.~~~
Work (a cam) ,3 s F- gt5 ~ ~ Cell
3 5 ~~ - 3 .%~ 8'"~"
FAX 35~~ ~S8'~"
C0IVTRACTOR: ~ ~-s~-o...~~,~.~ s ,~ /< L.a,, r
MAILING ADDRESS: ~"sS s',~//~~i.,.... /-/ur~crCITY_ ~~G~~~ STATE--L~- ZIP ~'-~~~'
PHONE: Home#
EMAIL
Work# ~ ~~-~a-~ Ce[1#
_F~ x.56 ~ 39 ~~
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property}
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial; Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalq~ of perjury, [hereby certify
that 1 have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me
in hearings before the Planning and Zoning Commission or the City Counci] for the City of Rexburg shall be truthful and correct. i agree to comply
with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives ofthe City to enter
upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions of the 20001nternational Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval was base~~nit vo tf not st ithin 180 days. Permit void if work stops for l80 days.
~ ---~1 3Q ~~~-
Signature of Owner/Applican DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning Januan: 1, 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
''~*Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
Jan 30 06 11:27a Myron Creager
1Peease complete the enti~Application!
applicable
NAME v> ,~-~ ~_- a .%~-~.-~
PROPERTY ADDRESS `~ ~ ~` 5 S o ~v ir,.
SUBDIVISION
Permit
Required!! 1
MECI~ANIC~IL
Mechanical Contractor s Name: -- Business Name: C.-r-~- m~S ~• ~-~,~- w~
Address ~S9 5= ~~/o~~ ~µ,~ ~yc~l City_1l_ ~~~~ ~ State T_ ~ Zip~`f'f`/v
Contact Phone: (~') j S 5'- ~D~gc Business Phone: ( ) ~i~-~+--~'
Email
Fax 3 S~ - 35' is ~'"
1Vlechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES 8c APPLIANCES COU11%T (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fred appliance
Incinerator System
Boiler
Pool Heater
208-356-3988 p,2
If the question doe~t apply fill in NA for non
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents ~ ducts:
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
.~
~ ~G ~ /- 3 ~ - o~
Si~nalure .'tensed Contractor License number Date
Required!
The City of Rexburg s permit fee schedule is the same as required by the State ofldaho
5