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N r ~ __ ~ Z N ~ ~ IV j I-O ~ iV ~ I~ ~ I I~ i~ ~ ,~ ~ '~ i 1 - ,Q Q ~ ~ Q CITY OF REXB UR G ~ ~ PERMIT # ©~ ©0 ~ ~ ~' 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: SUBDIVISION: /~ ~ UNIT#~BLOCK# ~~} LOT# /y/~ P.,,,,,,,,,,;y~, P OWNER: , ~~~ ~~~~~/~/ CONTACT PHONE # 3~ Cv "©~ d Co PROPERTY ADDRESS: 2 ~$ ~ST ~i v~ -~ D2. PHONE #: Home ( ) ~S ~'~v3j ~ Work ( ) ~~ ~_.4'~CJCa Cell ( ) ~~~/ ' lv,~ Is~ OWNER MAILING ADDRESS: ~~ ~ ~y~r~zx~,~CITY: ~x8u STATE: ID ZIP: ~3 yy~ APPLICANT (If other than owner)~,zl ~ ,,~5 ,~} ,~ ~/~, (If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) MAILING ADDRESS OF APP ICANT lu7 rMc~v~~c:.~~~~ ~. CITY: - STATE; j ~ ZIP ~~yYn PHONE #: Home ( ) ~ f~ ° ~3 i ~ Work ( ) 35~; -O/ OG, Cell ( ) 3s / " ~ 3 f S~ CONTRACTOR: /~,~,~ PHONE: Home#~Work# ^/~9 Cell#~ MAILING ADDRESS: CITY NA STATE N~ ZIP /VII How many houses are located on this property? /~~„~ Did you recently purchase this property No Yes (If 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, ti 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 d~. Perm}t voidif work stops fcar 180 days. 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 t~. ~ti- -V 1~ • • PROPERTY ADDRESS Z'~ b,~,~€~~ ~~ • Permit# SUBDIVISION N ~ Dwelling Units: ~' Parcel Acres: IU~ SETBACKS FRONT N ~ SIDE ~~ SIDE nla~ BACK ~Y I~- Front Footage (if applicable) ~ ~ Storm Water Length ~ !~ SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area /~,l~~t Unfinished Basement area /l1/~ Second floor/loft area !Y /~ Finished basement area Q Third floor/loft area /V /}~ Garage area Shed or Barn /l'- (~ Carport/Deck (30" above grade)Area ~~ Remodel (Need Estimate) $ Z O, d C~ PLUMBING Plumbing Contractor's Name: ~~D ~ 1~'~~ Business Name: ~71e~C-ti`-~~rC-p ~tfcx.mlSl~K.r, Address ~~" ~ State Zip Contact Phone: ( ) ~"" - ~ Business Phone: ( ) ~ ~- `/ ~'/~ C~ FIXTURE COUNT Clothes Washing Machine Sprinklers Dishwasher Tub/Showers Floor Drain Toilet/LTrinal / Garbage Disposal Water Heater Hot Tub/Spa Water Softener Sinks ~ (Lavatories, kitchens, bar, mop) Plumbing Estimate $ ~~ (Commercial Only) __ ~-- ~' ~~,.~/.~!~~ ~~ i f ~ f~- mss..,-- Signature of Contractor License num er Date The City of Rexburg's permitfee schedule is the same as required by the State ofldaho 2 t MECHANICAL Mechanical Contractor's Name: L Business Name ~~~ G~~~ Address '7 Z State ~ p Contact Phone: (~ ~ B i Ph ~ us ness one: ( ) FIXTURES & APPLL9NCES ~ ~ Furnace ~ Unit Heater - Furnace-Air Conditioner Decorative Gas-Fired _ Combination ~ Appliance Heat Pump - Space Heater Air Conditioner ~~ Incinerator - Evaporative Cooler ~ Broiler Pool Heater EXHUAST & VENTILATION Dryer Vents Cook Stove Vents ~ ~~p Range Hood Vents - Bath Fan Vents ~ ~ ~o,,l -~'S7J Fuel as Pipe (# of Outlets) i 5 aaG Mechanical Estimate $~ (Commercial C~--+ On1Y) f / ooS ignature of Contractor License number ate The City of Rexburg's permit fee schedule is the same as required by the State ofldaho WATER METER COUNT WATER METER SIZE HEAT (Circle all that apply as Oil Coal Fireplace Electric ~` ~~ , ,r..J ~~ °i/ \ ~ ~4 3 ~~ ~ ~. _ ~ '~ ~ °~a Z 1 v ~. ~~ ~~ \~ "' J OCR ~ ~ s ~' ~- ~ ~, ~ 39"-6' 1 r n 0 4 Q t~ a D o rri k a ~~