HomeMy WebLinkAboutALL DOCS - 05-00049 - Valley Professional Pharmacy - CarportCITY OF REXBURG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
• PERMIT # O ~ ~~ a
1
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
PARCEL NUMBER: ~ ~ ~ ~X ~ ~ ~~ ~ ~ ~ ~~
SUBDIVISION:
UNIT# BLOCK# LOT#
OWNER: ~'p~p/t ~L °L CONTACT PHONE # v`~a~- ~ .~6 6 S3 5~
PROPERTY ADDRESS:
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PHONE #: Home (x )~~ ~2¢ 7gs3 Work (IC) ~~ 3~~~Ce11(k) .ZOS' 7~ p ~~l
OWNER MAILING ADDRESS: ~3 ~ ~ , ~ S ~ /V. CITY: ~ C~cw STATE:.~y/ ZIP: I~34«
APPLICANT (If other than owner) ~d~1-
(If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
MAILING ADDRESS OF APPLICANT ~Frn^~ A S ~` ~ ~ v~-
~~- CITY: X14 STATE; ~~ ZIP ~~-
PHONE #: Home ( ) N}~ Work ( ) ~/ Cell ( ) /V~-
CONTRACTOR: G~N~. STo~•C~.-d!
2
PHONE: Home# ~q~ ~~ Work# /~ f~ Cel~~ /7-,67~
MAILING ADDRESS:~o7 ~J~ '~00~~ CITY ~Aiv~ STATE ~ ZIP ~~4~~5
How man houses are located on this ro ert ~ ~Q~~'h'-'>~~~'«1 ~ p
Y p p Y• b-uS;.~~sl' e a~ cvr4~G p/.~'~''~~`J
Did you recently purchase this property? ~ Yes (If yes give owner's name)
Is this a lot split?~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ~A~'-'~'-y1C'B'~'~~
(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
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. Permit void if work stops for 180 days.
Signature of Owner/Applicant
l ~ ~ / ~G~S
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 Rexburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application**
*xBuilding Permits are void if you check does not clear**
• •
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units:,
SETBACKS
FRONT
SIDE
SIDE
Permit#
Front Footage (if applicable)
Storm Water Length
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area
Second floor/loft area
Third floor/loft area
Shed or Barn
ov
Remodel (Need Estimate) $ ~~0~
Water Meter Count:
Unfinished Basement area
Finished basement area
Garage area
Carport/Deck (30" above grade)Area
Water Meter Size:
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 $
BACK
/ ~ Tub/Showers
G Toilet/LTrinal
Water Heater
Water Softener
(Commercial Only)
Signature of Contractor License number Date
The City of Rexburg s permit fee schedule is the same as required by the State ofldaho
Parcel Acres:
_Business Name:
State Zip.
2
„ .
• •
• NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
MECHANICAL
Mechanical Contractor's Name: Business Name: _
Address State Zip
Contact Phone: ( ) Business Phone: ( )
FIXTURES & APPLL4NCES COUNT
^ Furnace
^ Furnace/Air Conditioner mb ^
^ Heat Pump ^
^ Air Conditioner
^ Evaporative Coo er
^ Unit Heater
^ Space Heater
^ Decorative gas-fired appliance
erator ^ Exhaust or Vent Ducts
.r ^ Dryer Vents
He ^ Range Hood Vents
.ar tares r ^ Cook Stove Vents
es: ^ Bath Fan Vents
^ Other similar vents & ducts:
^ Fixtures or Appliance outlets of the gas piping system
Mechanical Estimate $_~_ (Commercial Only)
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric ~~-
Point of Delivery must be shown on plans.
Please check all that Apply:
Signature of Contractor
License number
Date
The City of Rexburg's permit fee schedule is the same as required by the State ofldaho
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