HomeMy WebLinkAboutAPPLICATIONS, MULT DOCS - 05-00130 - 624 Vale Ln - Basement FinishZ
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G. Q
CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440 Please c~
208-359-3020 X326 If the questio
Karl Basement Finish 624 Vale
PARCEL NUMBER: 2p R. ~ ~v y ~ cA ~ ~ ~ Grp
SUBDIVISION: ~ ~~ vc.~ ~ a ALE ~ UNIT# BLOCK# ~.. LOT# 1 cD
OWNER: ~cz~c.. ~ ~A2L CONTACT PHONE # ~ p , _ ~5(n - ~Z SS
PROPERTY ADDRESS: /ooZ4 yA~ LN I~e~t3u~.c~ ~~ £3340
PHONE #: Home ( ~st~-b2.P,g Work (~) ~g~-3og1 Cell( )
OWNER MAILING ADDRESS: s~~.~,~ as ~~c CITY:
STATE: ZIP:
APPLICANT (If other than owner) ~tA-
(If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
MAILING ADDRESS OF APPLICANT
ti~ CITY:
PHONE #: Home ( ) tiA Work
CONTRACTOR: ~,-a PHONE: Home#
STATE; ZIP
Cell ( )
Work# Cell#
MAILING ADDRESS: N~- CITY STATE ZIP
How many houses are located on this property? ~
Did you recently purchase this property? No es If yes give owner's name) E~yc C3 tGA~~.
Is this a lot split? NO YES (Please bring copy of new legal description of property) ,
~~N~Sh
PROPOSED USE: S~:~G~ F'AM~W ~~vE~-x-~ ~ ~ ~s~l.,~r~~~
(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 sto for 1 ays.
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
City of Rexburg's Acceptance of the plan review fee does not constitute plan
**Building Permit Fees are due at time of application**
**Building Permits are void if you check does not clear**
J nn M
a ~l ~ ~ ~.J l~J ~ ~n;3
APR 2 6 2005 u'
By
9
X
NAME ~~~c ~ KA.e~. ~ ~ Q ~, ~ O
PROPERTY ADDRESS ~a4 ~~~ ~~ ~,~~~,,~ ~a ~3~4c~ Permit#
SUBDIVISION E-1~0~.~ VAU~y
Dwelling Units: ~-
SETBACKS
FRONT ~~. SIDE
SIDE
BACK
Front Footage (if applicable) ~ ~
Storm Water Length ~,,.~
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement area t r~5~gzt ~-ti-Z
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) $ ~ QQQ
PLUMBING
Plumbing Contractor's Name: ~ usiness Name
Address tate
Contact Phone: ( ) Business Phone: ( )_
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)
Signature of Contractor
Parcel Acres: c~ t 3
License number
Date
The City of Rexburg's permit fee schedule is the same as required by the State ofldaho
~p~ ~
_Zip
2
t
MECHANICAL
Mechanical Contractor's Name:
Address
Contact 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
Business Name: _
State Zip
Business Phone: ( )
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 ofRexburg 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
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