HomeMy WebLinkAboutBP & APP - 06-00066 - 45 S Hidden Valley Rd - FireplaceZ
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C1'TY OF' REXB URG
BUfLDING PERMIT APPLICATION
~9 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PERMIT #
~f fhe l:a tai
PARCEL NUMBER:~j(~~r~)~ j ~~,J t~ ( 46 ~~~66
SUBDIVISION: '~-""` ~~ S Hidden Vallee Rd-
(Addressing is based on the information -must be accurateU MCCha111Ca>I
OWNER: ~~(~ L;~S/~,.,~G ,,~ CONTACT PHONE #
3SG~S~~6
PROPERTYADDRESS:~S 5.~ 71~~1.e,~y„~~ /~~
PHONE #: Hame (~~ <3Sv-~j~6 Work ( ) Cell ( )
OWNER MAILING ADDRESS: ~ ...~.r
CITY: , ~b~ STATE:~~ ZIP:~S':3<f/~{~
EMAIL FAX
APPLICANT: (If other than owner) ~ ~ ~ ~~5.< ~, ,~-~
(Applicant if other than owner, a statement authorizing applicant to act as
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agent for owner mast accompany this application.)
APPLICANT INFORMATION: ADDRESS ~S4 ~)-P~1~~5'!~/CITY: ~~~~,,5-~
STATE;_ Y7 ZIP ~f~G~ EMAIL F~ 3~"'G- ~'S'88"
PHONE #: Home ( ) Work ~) 35~-$~~ Cell
( )--
CONTRACTOR: _ ~ ~,~ ~ ~, ~ ,
S ti. ~rI'-~~~cu3
e
MAILING ADDRESS: ~9 S'- ,~/Jb,,~, T~'~ ~,y/ CITY ~,~-,(~
~~~-' STATE~~D ZIP cf~
PHONE: Home# Work# ~S°= 8`~~Sr Cell# _
EMAIL FAX ~S~ - .~ S'8-'I'' I U 1 ~s ~ LS Ll ~~l t5 I ~ ~
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.)
0
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under enat of
have read this application and state that the information herein is correct and l swear that any information which may herea8er be given by me in hearings beforeylhe 1
Planning and Zoning Commission or the CitS~ Council for the Ciry of Rexburg shall be truthful and coaecE. I agree to comply with alf Ciry regulatiora and State laws
relating to the subject matter of this application and hereby authorized representatives of the City to enter upon Ehe above-mentioned ro
NOTE: The building official may revoke a permit on approval issued under the provisions of the 2000 lntemational Codc in cases of anyefal a statementrprs purposes.
misrepresentation of fact in the application or on Ute plaru on which the permit or approval was based. Permit void ifnot started within 180 days. Permil void if work
stops for 180 days,
- ~-
Signature of OwnerlA scant o~1 ~ / ~c
Do you prefer to be contacted by fax, email or phone? Circle One DATE
~'~'ARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SLTE!
Plao fees are non-refundable and are paid in full at the tune of application beginning.Tanuarv 1,1005
City of Rezbnrg's Acceptance of the plan review fee does Qot constitute plan approval
3
£~d 886£-998-802 aaBaaaC uoa~(W d~~b;~0 90 60 qa~
--,;:
~;Aplicui~l
•„ NAME ~~~ ~: flu-vta ~.
PROPERTY ADDRESS_1lS5• ~d~~~~ y ~
SUBDIVISION
Permit#
ec~z~~~e~ , f
1VIECHANICAL
Mechanical Contractor's Name: ~ ~~ Croo~,~ ~i
Business Name: C'~5~~. D.~ , „• ,~,
Address_ ~ ~ ~ 5- ~P~J ~ ~ ~ - }' 3
> , ~ ~d ~ City ~- ~ '~~~_State ~~ Zip g31«~~
Contact Phone: (dog) ,~S ~ - ~dZ~ Business Phone: ( ) S~ ~--~
Email
Fax 3.5~ ~,~" 9 4-~`
Mechanical Estimate $ (CommerciaUMuiti Family Only)
FIYT'URES & APPLIANCES COUNT" (Single Family Dwelling Only}
Air Conditioner
Bath Fan Vents
Range Hood Vents
Boiler
Cook Stove Vents
Decorative Gas Fireplaces
Dryer Vents
Evaporative Cooler
Exhaust or vent ducts
~_ Fuel (gas) piping fixtures or appliance outlets
Furnace
FurnacelAir Conditioner Combo
Heat Pump
Incinerator
Pool Heater
Heat (Circle all that apply} ~~Oil Coal Fireplace Electric
Space Heater
Unit Heater
Mechanical Sizing Calculations must be submitted with Plans & Application
oint of Delivery must be shown on plans.
C
Signature nfT_~cc eV Contracior
~. ''~~'v >~~ License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
5
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~~d 886£-95£-802 ~a6eaa~ uoa~(W d9~:ti0 90 60 9a~