HomeMy WebLinkAboutAPPLICATION - 06-00096 - 2471 N 2000 W - Fireplace" L~'l~'Y OFREXB URG ~ PERMIT #
BUILDING PERMITVAPPLICATION Please ~
19 E MAIN, REXBURG, ID. 83440 If the ques
208-359-3020 X322
PARCEL NUMBER:
SUBDIVISION:
(~
06 000~~
2471 N 2000 W-Cnty Mech
UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: ~~~~ /~ ~O?CI LCJ ,~'~?~~,C,~~
PHONE #: Home ~~)~~ ~Ij~ Work ) Celle) ~>`^~ -- ~~%~
OWNER MAILING ADDRESS: ~~~ CITY:
EMAIL
FAX
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; ZIP
PHONE #: Home
CITY:
EMAIL
Work
Cell
CONTRACTOR:
MAILING ADDRESS:_~~~ ~ ~~ ~ CITY~`~ ~-A
PHONE: Home# ' a°'S~~ Work#~~,~~ -~jw Cell# ,~/~ - ~/ 7G'
EMAIL
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
STATE~ZIP
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 penalty of perjury, I hereby certify
that I have read this application and state that the information herein is correct and I swear that any information which may hereafrer be given by me
in hearings before the Planning and Zoning Commission or the City Council 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 of the City to enter
upon the above-mention d property for ' spections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions of the 20 I ternational m cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval w~s asgd., Pe it ~i,~f not started within 180 days. Permit void if work stops for 180 days.
Signature of Owne~/Ap~licant `~
/~/ y ~"
DA'Z'E
Do you prefer to be contacted b}I fax, email or phone? Circle One
FAX.
FAX
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 January 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**
`P7ease comp~'"l~e~'Tie eri~Ire pp~ica~ion. ~If the question does not apply fill~~in NA for non ~~
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address
Contact Phone:
Email
_City
Business Phone:
Fax
State Zip
Mechanical Estimate $ ~~ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (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-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply Gas it Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
ature o Lice ed Contractor License number
~~~~~
Date
MECHANICAL
~~ ~ ~ ~~.5 Business Name: ~~~~~.