HomeMy WebLinkAboutAPPLICATION - 05-00141 - 261 E 3rd S - Lawn SprinklersCITY OF REXB URG PERMIT #
BUILDING PERMIT APPLICA~N
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
Please c
If the questii
05 001 ~~
PARCEL NUMBER: ~,~' 1Z~~IZ ~ °d s ~ QS~` Summers Sprinkle r
SUBDIVISION:
UNIT# BLOCK# LOT#
OWNER: ~ o~r~ ~ `~ (~~,-~e, ~~ ~yy~~/~/~ CONTACT PHONE #~ f~ J~ " ~Z~ ~Ii
PROPERTY ADDRESS: ~`Q' C7 ~ ~/YLb SO
PHONE #: Home ( ) [~Q - 3 ~L~Z Work ( ) S 2y ~~;0?~ Cell ( ) s ~I - ~ 32 (~
OWNER MAILING ADDRESS:
CITY:
STATE: ZIP:
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
2l~ ~ ~ ~ ~~-'P SU . CITY: 12t < STATE;~`~ ZIP ~~{ ~ ~
PHONE #: Home ( ) lp~;lt - 3LQ~ Work ( ) - 0 Z~ Cell ( ) dal -~- 32 ~./
CONTRACTOR: PHONE: Home# Work# Cell#
MAILING ADDRESS: CITY STATE ZIP
How many buildings are located on this property?
Did you recently purchase this property? No es (If yes give owner's name)
Is this a lot split? ~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ~~ WlU ~ ~ ~AIIM ~~ l . I~~/IS~VI~/I/l~ ~t~GfN ~ -'~1~-~~
(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 withJip.18Q days. Permit void if work stops for 180 days.
Signature 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 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**
Please complete the sire Application!
If the question does not apply fill in NA for non applicable
NAME
PROPER'
SUBDIV]
Dwelling Units:
SETBACKS
FRONT
DRES S
SIDE
Front Footage (if applicable)
Storm Water Length
Remodeling Your
(need Estimate
BACK
Permit#
SURFACE SQUARE FOOT~rE: (Shall include the exterior w~measurements of the building)
First Floor Area
Second floor/loft
Third floor/loft a:
Shed or Barn
Water
Required!!!
PLUMBING
Plumbing Contractor's Name:
Address
Contact Phone: ( )
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
(Commercial Only)
Parcel Acres:
Sprinklers
Tub/Showers
Toilet/LJrinal
Water Heater
Water Softener
Unfmished Basement
Finished basement area
Garage area
Carport/Deck (30" above grade
Water Meter Size:
Business Name:
State
Business Phone: ( )
Zip,
Signature of Licensed Contractor License number Date
The City of Rexburg s permit fee schedule is the same as required by the State of Idaho