HomeMy WebLinkAboutAPPLICATION - 05-00164 - 191 Huckleberry Cir - Lawn Sprinklers'OF REXB URG
LDING PERMIT APPLICATION
E MAIN, REXBURG, Ip. 83440
~8-359-3020 X322
..PARCEL NUMBER:
PERMIT # •
Please complete the entire Application!
)~f the question does not apply fill in NA for non applicable
SUBDIVISION: U1
(Addressing is based on the information -must be accurate)
05 oo~s4
Sprinklers - 191 Huckleberry
CONTACT PHONE # ~ -~ $~
PROPERTY ADDRESS:
PHONE #: Home (~l 557, -S$~_ Work (?,.1) ~ - 7..-'1 Sr Cell (?~ ~.et - ! ?Go
OWNER MAILING ADDRESS: SA~,~ CITY:', STATE: T~_ZIP:~d
EMAIL ;orwtl. VinAiwid~bya.~FAX 111l~
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home
CITY:
FAX
Work ( ) Cell
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? /
Did you recently purchase this property? No Yes (If yes give owner's name).
Is this a lot split?~~i0) YES (Please bring copy of new legal description of property)
PROPOSED USE: ~~ Ic n,
(i.e., Single Family Residence, Multi Family,
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.
of Owner/Applicant DATE
prefer to be contacted by fax, email or phone? Circle One
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 Rez6urg'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**
~.
r •
ase com lete the entire A lication!
p PP
If the question does not apply fill in NA for non applicable
AME~J Mts [; •rdet
~~ROPERTY ADDRESS X41 {-~we~lt-s~.-ra Cyr Permit#
SUBDIVISION ~y+Ltrtt...
Dwelling Units: Parcel Acres:
' SETBACKS
FRONT "SII~F . SIDE BACK '
.;
.. , ",.
Remodeling Your Building/Home (need estimate) $
SURFACE SQUARE FOOTAGE: (hall, include the exterior wall~measu~ments of the 13u~lding) '' '
First F1oo~~Area' '
Second floor/loft area
Third floor/loft area
Shed or Barn
Unfinished Basement area
Finished basement area
Garage area
Carport/Deck (30" above grade)Area
Water Meter Count:
Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name:
Address
Contact Phone: ( )
Email
City
Business Phone:
Fax
State Zip.
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine ~ Sprinklers
Dishwasher Tub/Showers
Floor Drain Toilet/Urinal
Garbage Disposal ' ~ Water Heater
Hot Tub/Spa Water Softener
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $ (Commercial Only)
• aSignature of L,ic2hseri Contractor
The City of Rexburg's p
License number Date
e schedule is the same as required by the State ofldaho
Business Name: