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HomeMy WebLinkAboutAPPLICATION - 05-00239 - 1005 Westwood Dr - 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) CONTACT PHONE # 3 5~ ° ~ ~ ~ ~ PROPERTY ADDRESS: ~Ot~ S /,~~ S~w~ p~1 ~~~, PHONE #: Home (aa$~ ~ ~~ - X335 Work Cell (~2v$) 7G~ ~ `~ ~ S2- OWNER MAILING ADDRESS: /y05 ~ Q s-~~~,~CITY: ~ STATE:~ZIP:p EMAIL FAX APPLICANT (If other than owner) ~ ~~ ~j ~ ~~ ~ ~~ ,~_ ~ P f ~ ~ ~~ y~ - ~ ~ - ~~w .-f -p . (Applicant if other than owner, a statement authorizing ~plicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS ~ ~ (,tyQ ~ •~-u~aoc~ ~Y;CITY: .Z, STATE; ~ ZIP__~L~ EMAIL ~ ~ ~ FAX ~ p ~ ~ gam/ PHONE #: Home ~©8f ~3 ~G-~~'3.3~' Work ~o}~ ,, - Q~ Cell (~o~'' 3 l 3 ! U ~'"l CONTRACTOR: MAILING ADDRESS: CITY STATE ZIP PHONE: Home# Work# Cell# EMAIL FAX How many buildings are located on this property? (? i'le Did you recently purchase this property? No Ye~,~If yes give owner's name) ~oh~ u "n ~~7ey~p~~ Crr,•~~,~) Is this a lot split? ~ YES (Please bring copy of new legal description of property) // PROPOSED USE: i E-L (i.e., Single Family Residence, lti Family, PERMIT # Please complete the entire Application! If the question does not apply fill in NA for non applicable 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 pe~t~r approval~yvas based. Permit void if not started within 180 days. Permit void if work stops for 180 days. / O /~ Si ure of ner/App ' an DATE Do you e er to b c ntacted by fax .mail phone? Circle One ING -BUILD ERMIT 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** Please complete the e~ire Application! ~` I~ ~ ( If the question does not apply fill in NA for non applicable NAME j( C~ f rl u.6j'L l'er PROPERTY ADDRESS /pp ~L~~~~,y~~c~ ~~- Permit# 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 (30" above grade)Area Water Meter Count: Water Meter Size: Required!!! PLUMBING Plumbing Contractor's Name: ~ of 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 $ Unfinished Basement area Finished basement area_ Garage area Fax Zip ~~ Sprinklers Tub/Showers Toilet/L7rinal Water Heater Water Softener (Commercial Only) Parcel Acres: State 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