HomeMy WebLinkAboutAPPLICATION - 05-00201 - 742 Pinehaven St - Lawn SprinklersCITY OF REXB URG •
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER• `~_ ~~a ~-~r.~,,.xo ; ~ ~ CONTACT PHONE #
PROPERTY ADDRESS: 7~a ~~, e ~~,,,.P~ 1~~~
PHONE #: Hom~) 3 5/ - 3 ~~ Work ( ) Fell ( )
OWNER MAILING ADDRESS: 75~~ P,~rz.e-~¢,v-ew ~ CITY: STATE ZIP: ~3,~~0
EMAIL FAX
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 CITY:
STATE; ZIP EMAIL
PHONE #: Home ( )
PERMIT #
Please com lete th•ntire A lication!
P pP
If the question does not apply fill in NA for non applicable
Work
FAX
Cell
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? (~ p _
Did you recently purchase this property? No Yes If yes give owner's name) LE~,~N~ ~~'i.DE~2
Is this a lot split NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(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
permi r approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
i
C~ a ~ l ~ ~J i ~s
Signature of Owner/Applicant DATE
Do you 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 I, 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**
Please complete the e>~re Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units:
SETBACKS
FRONT SIDE
SIDE
BACK
Remodeling Your Building/Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor 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:
Permit#
Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name: Q~ Business Name:
Address City
Contact Phone: ( ) Business Phone: ( )
Email
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
Fax
~_ Sprinklers
Tub/Showers
Toilet/Urinal
Water Heater
Water Softener
(Commercial Only)
Parcel Acres:
State
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
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