HomeMy WebLinkAboutAPPLICATION - 05-00216 - 366 W 3rd S - Plumbing1 ~'Y OF REXB URG i
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
SUBDIVISION:
(Addressing is based on the information - mu
OS 0016 ,
Plea ~ ~n•
If the Hariey(MaStier P1U111b111~ able
66W3rdS
( we will provide this for you)
UNIT# BLOCK# LOT#
st be accurate)
CONTACT PHONE # ~~ 3 - q t~l - q 213
PROPERTY ADDRESS: 5 (, (. (~! ~ c
PHONE #: Home ( ) ~ S °t - ~(D 1,1o Work
OWNER MAILING ADDRESS:
EMAIL
CITY:
STATE: ZIP:
APPLICANT (If other than owner) i(V~, ct Sf e r '~ lu,w~b ; v~rt ~ ~ ~ c~~~n o ~ att S
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS ~ ~• _7, q li N ~ l 1 S E - CITY: ,L dl~Ir~o ~al is
STATE; ~ ZIP 6 3q O ~ EMAIL
PHONE #: Home
FAX
FAX
Work ( ) S 3 8 - So (~ !~ Cell
CONTRACTOR: ~V~o~,S{~ ~(,,.,~~ ,,,~,~ _
MAILING ADDRESS: S t`aw` ~ CITY
PHONE: Home#
EMAIL
Work#
FAX
Cell#
How many buildings are located on this property? t
Did you recently purchase this property?moo) Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: ~~.1+ ~ ~~ ~ ~y ~ _
(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 approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email o on 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 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**
STATE ZIP
Cell (soa) R ~q - R 213
i lease com lete the en i• - ~
p t e Application.
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS 3 GL t,~) 3 crl(S Permit#
SUBDIVISION
Dwelling Units: ~ Parcel Acres:
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building/Home (need Estimate) $ / Soc~°~ Plu.«1b~q
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
(30" above
Water Meter Count:
Water Meter Size:
Requi~'ed!!!
PLUMBING R~sselc c3a~k~e ~-
Plumbing Contractor's Name: ~AocSker ~~uMn~n«•n Business Name: ~a~(-~ ~~u,,,,~`~, o ~ ~, ~a(( 5
Address <<-E3c( ~. IJ~ ~ ~~ E City .ida~o ~a~~S State Z d Zipt~3~{p~
Contact Phone: ( )r, 3 8 5 b ~ ~ Business Phone: ( ) ''
Email ~ Fax S 'i 8 7 3 t Z
FIXTURE COUNT (includins roughed fixtures)
Clothes Washing Machine Sprinklers
Dishwasher _~ Tub/Showers
Floor Drain oZ Toilet/Urinal
~-
Garbage Disposal ~ Water Heater s~~
.Hot Tub/Spa Water Softener
~_ Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estima>te-$ !! S Do °O (Commercial Only)
~wyves?~ ~ cam- ~. l 1 `i ~ ~{ ~ . 7 _ o ~
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