HomeMy WebLinkAboutAPPLICATIONS, BP - 05-00038 - 1010 Hillview Dr - Basement FinishZ
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CITY OF I'EXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
• PERMIT # ~ ~ d~ ~~~
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
PARCEL NUMBER: ~ ~ OC- . ~ 0 ~.~ I LI Cog
SUBDIVISION: ~ ~;
~~~t,'~-~G ~ UNIT# BLOCK# LOT#
OWNER: _~ ~ ~ ~~ a l.~ TACT PHONE # -~(, ~ 35~. __ ~~ S~ l~
PROPERTY ADDRESS: ~ L' II"~ ~-~i,{'_~.LrLp,G(,~ ~~,.~c 12,tt~"c;,
PHONE #: Home (;`lam ? S ~ _ ~~~ Work
Cell
OWNER MAILING ADDRESS:~~ ~,~~~, ~ -CITY: ' STATE,~jZZIP:
APPLICANT (If other than owner) (Y~,-„~,-,~,~ ,~,, !`, , (y - ;
(If applicant if other than owner, a statement authorizing applicant to ct as agent for
accompany this application.)
MAILING ADD S S OF APPLICANT
?!~ S ~ ~ CITY: ~ ~~ STATE; _ ~ ZIP---
PHONE #: Home ~; ~ ~,4e~U ~~ Work ) Cell ( )
CONTRACTOR: ~p` ~ PHONE: Home#~Work# Cell#
MAILING ADDRESS:.3/~ ,S,~C~,i CITY STATE~_ZIP_~u
How many houses are located on this property? ~7~`L.~
. ~_ / _
Did you recently purchase this property? No Yes f 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,
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
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 o£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. Permit void if work stops for 180 days.
Signature of
~_~~ (~~~
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 ~ } rv~ i~1.1,11-Y~L ~~iy~ c~-~~--'"
PROPERTY ADDRESS
SUBDIVISION ~ ru,,,~e~~-~
Dwelling Units:
SETBACKS
FRONT SIDE
Front Footage (if applicable)
Storm Water Length
SIDE BACK
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
I
First Floor Area Unfmished 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) $ `'~'
PLUMBING
Plumbing Contractor's Name: Business Name:
Address State
Contact Phone: ( ) Business Phone: ( )
FIXTURE COUNT
Clothes Washing Machine Sprinklers
Dishwasher Tub/Showers
Floor Drain Toilet/LJrinal
Garbage Disposal Water Heater
Hot Tub/Spa Water Softener
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $ (Commercial Only)
Signature of Contractor
License number
Permit#
Zip.
Date
The City of Rexburg s permit fee schedule is the same as required by the State ofldaho
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Parcel Acres:
r
MECHANICAL
Mechanical Contractor's Name: =`~~~ Business Name: _
Address State Zip.
Contact Phone: ( ) Business Phone: ( )
FIXTURES & APPLL4NCES
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 permitfee schedule is the same as required by the State ofldaho
WATER METER COUNT
WATER METER SIZE
HEAT (Circle all that apply) Gas Oil Coal Fireplace Electric
3