HomeMy WebLinkAboutAPPLICATION - 05-00217 - 148 College Ave - PlumbingY OF REXB URG
PERMIT #
BUILIDING PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208-359-3020 X322 (~
PARCEL NUMBER: I ~' P R t~ ~(g ~ ~ ~~ ~~d (We will provide this for you)
SUBDIVISION:
UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS: ~~~ ~(,_'~~~/
PHONE #: Home (a.o~) ~35-~ gsg 7 Work ( ) Cell ( )
OWNER MAILING ADDRESS: fy~~/~ CITY: J~ STATE:~ZIP: S3~y~
EMAIL
FAX
APPLICANT (If other than owner) /~ r- ~/~~, ;,~
(Applicant if other than owner, a statement authorizing applicant to act as gent for owner must accompany this applicationn.)
APPLICANT INFORMATION: ADDRESS l~/3gL ~o ~/~'~ CITY: ?~'
STATE; ~ , ZIP~L EMAIL
PHONE #: Home (erg) t5~'3~ 30 6 ~ Work ( ) ~.,o Cell
FAX d'' ~-'~ ~q ~.
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home#
EMAIL
CITY STATE ZIP
Work# Cell#
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? 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 oe 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 a royal w~based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
of
0 7 iii ~~
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 1.2005.
City of Rexburg'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**
• . .
1 lease complete the entire Application!
NAME J If the question does not apply fill in NA for non applicable
~' Q /
PROPERTY ADDRESS '' Permit#
SUBDIVISION
Dwelling Units:
SETBACKS
FRONT SIDE
SIDE
Remodeling Your Building/Home (need Estimate) $
Water Meter Size:
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
(30" above grade)Area
Water Meter Count:
Required!!!
PLUMBING
Plumbing Contractor's Name: ~L~~ ar~1z.~- Business Name: ,z~~ ~-~ ~~lnu..h~
Address ~~~~~ ^l. / )S ~`~ f , City ~ - State .~ Zips
Contact Phone: ( ) ~S"3 SI-Sa~ ~ 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 stimate $ (Commercial Only)
Signature of Licensed ontractor
The City of Rexburg's p
License number
e schedule is the same as
f a~
Date
by the State of Idaho
Parcel Acres:
Unfinished Basement area
Finished basement area
Garage area
Fax
BACK
Sprinklers
Tub/S~iowers
Toilet/LTrinal
--~ater Heater
Water Softener