HomeMy WebLinkAboutAPPLICATION - 05-00113 - Hart Airplane Hanger - Sewer Line
CITY OF
RExBUR~
AMERICAS FAMILY COMMUnIIY
SEWER HOOKUP PERMIT
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 /Fax (208) 359-3022
Project Information Permit # OS 00113
Permit Type Sewer Hookup Permit Project Name Hart Sewer Hookup
Site Address 265 CHUCK YEAGER WAY Parcel # RPRXBCA0241201
Project Description
Names Associated with this Project
Type Name Contact Phone # License # Exp Date
Applicant Rexburg-Madison County Airport
Owner Rexburg-Madison County Airport
Fee Information
Project Valuation
Hookup Fee/Sewer 905.00
Total Fees Paid $905.00
Print Name Date Issued:
Signature Date Issued sy:
CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440 Please ~
208-359-3020 X326 If the questi
PARCEL NUMBER: ~ P ~„~ ~ p a ~- I ~0 ~
SUBDIVISION:
05 00'! 13
Hart Sewer Hookup
UNIT# BLOCK# LOT#
OWNER: ~~~ ~,'~ ~' 1~-d2 T- CONTACT PHONE # 3 S~ G 7 c0=3
PROPERTY ADDRESS: ~~ 2•~C~J
PHONE #: Home ( ) ~S ~ 6?J,3 Work ( )
Cell ( ) 3J ~ 6'Z~3
OWNER MAILING ADDRESS: P~ B.~x G 33 CITY: ~~ J STATE:1'~J ZIP: ~~ ~' ~ p
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
CITY:
STA'
PHONE #: Home ( ) Work ( ) Cell
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home# Work#
How many houses are located on this property?
CITY
Did you recently purchase this property? No Yes (If yes give owner's name
ZIP
Cell#
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
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
1.3 /~Ljll '~-crJO ~T
D TE
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 Regburg'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**