HomeMy WebLinkAboutAPPLICATION - 05-00003 - Familian NW Addition~ ~
~,-,-r of COMMERCIAL ADDITION
~ : R.~BU~ City of Rexburg
AMERICAS FAMILY COMMUNITY
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 /Fax (208) 359-3022
Project Information Permit # OS 00003
Permit Type Commercial Addition Project Name Familian NW Addition
Site Address 240 DIVIDEND DR Parcel # RPRRXBP004002B
Project Description
Familian NW Addition
Names Associated with this Project
Type Name Contact Phone # License # Exp Date
Applicant Jensen Brett Etal
Owner Jensen Brett Etal
Contractor Brett Jensen Construction Brett Jensen 208-359-9593 NONE RECORDED 12/31/2004
Fee Information Project Details
Bid Price from Applicant 1 TOTA
Project Valuation $100,000.0(
Building Permit Fee 993.75
Plan Check Fee 99.38
Commercial Plumbing Permit Fee 30.00
Total Fees Paid $1,123.13
Print Name
Date Issued:
Signature Date Issaea sy:
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•
CITY OF REXB URG PERMIT # ~ti ~ ~~ (~
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440 Please complete the entire Application!
208-359-3020 X326 If the question does not apply fill in NA for non applicable
PARCEL NUMBER:
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SUBDIVISION: ~.,~~', L,~sS ~c~--,~ ~" UNIT# BLOCK# ~ LOT# ~ ~~-3
OWNER;~~~~ ~ ~ ~ CONTACT PHONE # ~J3- ~ ~~-~
PROPERTY ADDRESS: ,-~~~ ~~ ~> ~~~.
PHONE #: Home ,(~ 35~ -6~~~3 Work ( ) ~/ `.3 ~~ 73~e11( ) -~`~` ~ 7 ~~
OWNER MAILING ADDRESS: rO ..~~ 8y7 CITY: ~~ STATE:~/~ZIP:~S'S~o
APPLICANT (If other than owner)
(If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
MAILING ADDRESS OF APPLICANT
PHONE #: Home
STATE; ZIP
Cell ( )
CITY:
Work
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CONTRACTOR:~k%~'~v~-, L~,~ PHONE: Home# 3s'9 9S:~Work# Cell# 3/3-~' >3.6
MAILING ADDRESS: ~~ Sy ~ CITY ~~ k~w' STATE..,1r~ ZIP ~~~/O
How many houses are located on this property? L~ / /~t'~-e
Did you recently purchase this propert No Yes (If yes give owner's name)
Is this a lot spli . N YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garag Co dition, 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
hereafter 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-mentioned property for inspections purposes. NOTE: The
building official may revoke a permit on approval issued under the provisions of the 2000 International 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 based. Permit void if not
started within 180 days. Perm~id if work stops for 180 days. _
of Owner/Applicant
/ / ~ /
DATE
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 Rezburg'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**
NAME %Sf~'~ -
PROPERTY ADDRESS ~ Y~ ~/. ~, ~, ` ~;.
SUBDIVISION
Dwelling Units:
SETBACKS
FRONT SIDE
Front Footage (if applicable)
Storm Water Length
BACK
Permit#
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area ~~~ Unfinished Basement area
Second floor/loft area Finished basement area
Third floor/loft area Garage area
Shed or Barn Carport/Deck (30" above grade)Area
Remodel (Need Estimate) $ l~' DnU
PLUMBING
Plumbing Contractor's Name:
Address
Contact Phone: ( )
FIXTURE COUNT
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
(Commercial Only)
Signature of Contractor
License number
Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Parcel Acres:
d~
SIDE
Sprinklers
Tub/Showers
Toilet/LTrinal
Water Heater
Water Softener
Business Name:
State
Business Phone: ( )
Zip
2
MECHANICAL
Mechanical Contractor's Name:
Address
Contact Phone: ( )
FIXTURES & APPLL9NCES
Furnace _
Furnace-Air Conditioner
Combination _
Heat Pump _
Air Conditioner _
Evaporative Cooler _
Pool Heater
EXHUAST & VENTILATION
Dryer Vents _
Range Hood Vents
Fuel Gas Pipe (# of Outlets)
Signature of Contractor
Unit Heater
Decorative Gas-Fired
Appliance
Space Heater
Incinerator
Broiler
Cook Stove Vents
Bath Fan Vents
Mechanical Estimate $ (Commercial
Only)
License number
Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
WATER METER COUNT
WATER METER SIZE
HEAT (Circle all that apply) Gas Oil Coal Fireplace Electric
~ D~
Business Name: _
State Zip
Business Phone: ( )
3