HomeMy WebLinkAboutAPPLICATION, BP - 05-00090 - 616 Gemini Dr - AdditionZ
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CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
~~~ z t
If the quest
os 00090
Withers/Add fi 16 Gemini
PARCEL NUMBER:~P '~ TL~Q~ /~/j,~~~
SUBDIVISION: s~~r ~i ~~ ~{~_UNIT# BLOCK#~LOT#
OWNER: ~ ~C ~'I c2/' (i~ ~~'~"'~ ~!' S CONTACT PHONE # .35~- ~/~ ~ S
PROPERTY ADDRESS: I ~ C=~c~r32 t !'l l ~ /" • ~ ~ X rJ l.~ f G
PHONE #: Home ( ) ~ 5~ - ~~/5 Work ( ) ~~6 -y~bZ6 Cell ( )
OWNER MAILING ADDRESS: G / I'Yt 1 n ,r CITY: mac U r STATE ~ Q ZIP: 8~ ~ ~ U
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
PHONE #: Home ( ) Work
CONTRACTOR: $~~ 4.a .. PHONE: Home#
MAILING ADDRESS: CITY
How many houses are located on this property?
STATE ZIP
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? ~O YES (Please bring copy of new legal description of property)
PROPOSED USE: __i_. ____- ___ /'" ~-~-~ G~1'1
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, ddition 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
herea8er 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.
~~2~ ion
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 Januarv 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**
STATE; ZIP
Cell ( )
Work# Cell#
NAME ~ , ~~~ ~ :'gin k ~ ~ '?
PROPERTY ADDRESS 6!b Gc~r~t ~ ~ t
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT ~~ SIDE ~ ~ ~ SIDE_
~.
Front Footage (if applicable) ~~-
Storm Water Length
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area .~ X 2L ~ ~GQ4r-• G~6L~1 Unfinished Basement area Z~ X Z6~ (~,K,~'/ a~
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) $ ~ 5,0~
Water Meter Count: Water Meter Size: /~°~
PLUMBING
Plumbing Contractor's T
Address
Contact Phone:
FIXTURE
Clothes Washing Machine
Dishwasher
Floor Drain
~~a P~~~~
Business Name:
State
Business Phone: ( )
~_ ~,„ Permit#
~~ BACK '~°~-
Sprinklers
Tub/Showers
Toilet/Urinal
Water Heater
Water Softener
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
(Commercial Only)
Signature of Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Zip.
2
• NAME
PROPERTY ADDRESS
SUBDIVISION
^ Incinerator
^ Boiler
^ Pool Heater
^ Similar fixtures or
MECHANICAL
Mechanical Contractor's Name: /~ ~ _ Business Name: _
Address State Zip,
Contact Phone: ( ) Business Phone: ( )
FUTURES & APPLL4NCES COUNT
^ Furnace
^ Furnace/Air Conditioner Combo .
^ Heat Pump
^ Air Conditioner
^ Evaporative Cooler
Unit Heater
^ Space Heater
^ Decorative gas-fired appliance
Appliances:
Permit#
^ Exhaust or Vent Ducts
^ Dryer Vents
^ Range Hood Vents
^ Cook Stove Vents
^ 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 Electri
Point of Delivery must be shown on plans.
Please check all that Apply:
Signature of Contractor
License number
Date
The City ofRexburg s permit fee schedule is the same as required by the State ofldaho
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