HomeMy WebLinkAboutAPPLICATION - 05-00211 - 647 Dell Dr - Lawn SprinklersCITY OF REXB URG • PERMIT #
BUILDING PERMIT APPLICATION Please complete the
19 E MAIN, REXBURG, ID. 83440 If the question dog
208-359-3020 X322
PARCEL NUMBER: ~`~`~'SJ~/ j SO l C~Sb (We will ~
SUBDIVISION: UNIT#
(Addressing is based on the information -must be accurate)
entire Application!
,. _,_,..
OS X0211
Spr~nkier - b47 I)c;ll Dr.
OWNER:
CONTACT PHONE #
PROPERTY ADDRESS: ~/~// ~,
PHONE #: Home (~o~ 3s~- 37?r~ Work
Cell
OWNER MAILING ADDRESS: (~y7 7~(/ ~. CITY: yr STATE:/G~ ZIP: 3yy~
EMAIL ~ '~ ~' T ' ~'
APPLICANT (If other than owner) tzy~<cc /3, G~
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS ~ z s~ E ~ n! , CITY: /zex ~vU,..~
STATE; / () ZIP ~3 yyv EMAIL ~-ow.~_ ~zavr, ~ FAX C~~
PHONE #: Home ( ) `~~5~ _ 9 7 ~ Work ( ) ~-r'.r~ Cell (z~ ~ ~o - ~ ~~
CONTRACTOR: ,~ ' pivi ~4 .--- r i c ~ rv~.~
MAILING ADDRESS: /ZS~ ~ ~ ~~~(,~ CITY ~ , ,, STATE 1~ ZIP 3 y
PHONE: Home# 35 ~-~?Kc~ Work# ` Cell# ~3 ~p -- y78`c7
M Sn. co.-•-~
EMAIL ~>-~r,•~'n_F'~'la.~r«~ FAX (~~~ - /~'/5/~
How many buildings are located on this property?
Did you recently purchase this property?~N~Yes (If yes give owner's name)
Is this a lot split? (N~~ 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
permit or approva^was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of ner/Applicant DATE
Do you pre r 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 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**
<'lease com 1 ~'
p ete the entire Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Dwelling Units:
Parcel Acres:
SETBACKS
FRONT SIDE SIDE
Remodeling Your Building/Home (need Estimate) $
BACK
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
Water Meter Count:
Water Meter Size:
ltequi~ed!!!
PLUMBING c,~,-~~~.,1-0,~
Plumbing Contractor's Name: `~~-E-n~e ~",f-~~ Business Name:
Address- j ~~ ~ ~ N ~{~ City e~l~, State 1 i~
Zip c~3 ~[U
Contact Phone: ( ) 3 to- y 7 g a Business Phone:
Email Fax
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $ ~ S o ~ (Commercial Only)
Sprinklers
TublSh~owers
Toilet/IJrinal
Water Heater
Sign e of Licensed Contractor License number
The City of Rexburg s permit fee schedule is the same as
Unfinished Basement area
Finished basement area
Garage area
Carport/Deck (30" above ~
Water Softener
~'~s
Date
by the State ofldaho