HomeMy WebLinkAboutBP & APPLICATION - 05-00202 - 129 Madison Ave - GarageZ
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i
OF REXB URG , PERMIT # ~
~,,GDING PERMIT APPLICATION Please COriljJlete the entire AIJpI1Ca.t1011I
;:E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
,~1~8-359-3020 X322
..PARCEL NUMBER: ~P ~X nCA (~ ~. O 66 ~6 ~ (We will provide this for you)
t.. SUBDIVISION: UNIT# BLOCK#
I1,'R
(Addressing is based on the information -must be accurate)
LOT#
OWNER: j~u s s mot/ Q h a G'~.,-o i 4i0++/~ c r-s CONTACT PHONE # ~' p~ • 3 5 ~ - 5 ~S !ems
PROPERTY ADDRESS: 1~~7 ~`t~c~is~~ .4,re~ /~yl~u;~o
PHONE #: Home (ao~) ,3~~b- ~~/~ Work ( ) n/~. Cell ( ) i/,~
OWNER MAILING ADDRESS: ~,~q~f~so~rse,~ ,xl v'z CITY: xb u~ STATE: 1/~ ZIP: S~SI~a
EMAIL ~ ~w F fli erS ~ c~lnor . ~m 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
STATE; ZIP
PHONE #: Home ( )
CITY:
EMAIL
Work
Cell
CONTRACTOR:
MAILING ADDRESS: ~? 13. ~6lC 3fj CITY~~; L'ady` C'=~y STATE l D ZIPS
PHONE: Home#
EMAIL
Work# R'3.S-~ - ~ 3 ~1., Cell#
FAX
How many buildings are located on this property? ~e.s e d cv. ~U A ~, d. (~ s~orac~~ s~e:1.
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? ~~ YES (Please bring copy of new legal description of property)
PROPOSED USE: t,Ln-aft
(i.e., Single Family Residence, Multi Family,
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.
6 /~l D !"°
Signature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email o hone? Circle One -
WARNING -BUILDING PE ST 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 Regburg'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**
FAX
,.~;
~`OF REXB URG • PERMIT # •
l~L,DING PERMIT APPLICATION Please complete the entire Application!
;E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
,~~8-359-3020 X322
~~ -
;=`PARCEL NUMBER: R-~X ~,~ ~ 2 O 66 ~6 ~ (We will provide this for you)
SUBDIVISION: ~,~,~ UNIT# BLOCK#_
(Addressing is based on the information -must be accurate)
LOT#
OWNER: ~u s s ett o v: d G'~ r•n 1 1.10 fh ~ r.s CONTACT PHONE #_ „~ Qa' • 3 S ~ - S( !~
PROPERTY ADDRESS:---- j~~7 ~tctc~lsys-tr Avg ~,~~b~~-o
PHONE #: Home (~a~) t3~'b- S~L~_ Work ( ) n/,~ Cell ( ) i/.~
OWNER MAILING ADDRESS: 1,? 9 /Lfao~rsm,z /~ v'~ CITY: k~Px/, u~-~_STATE: t U ZIP: S.~ ,lyres
EMAIL ~ i~ w ~ f11 er ~ ~ va bear . ~~m 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
STATE; ZIP
PHONE #: Home ( ) Work
EMAIL
Cell
CITY:
FAX
CONTRACTOR: h~a ro ~ lea rrrs L~a~~ ~r~~ ~ ~~o-~~ 1 n G -
MAILING ADDRESS:-: ~ t3. ~6x 3b CITY LS I:CiCt.r ef~ STATE l D ZIP Sr~~la~'
PHONE: Home#
Work# ~3~~ ~33~Z 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? ~~ YES (Please bring copy of new legal description of property)
PROPOSED USE: l,~n_a~ f
(i.e., Single Family Residence, Multi Family,
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
pemut or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
6 /~/~
Signature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email o -hone? Circle One
WARNING -BUILDING PE 5T BE POSTED ON CONSTRUCTION SITE d
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**