HomeMy WebLinkAboutAPPLICATIONS, BP - 05-00251 - 325 S 3rd W - RemodelZ
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CITY 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)
OWNER: CON/TACT PHONE #
PROPERTY ADDRESS: ~ 2 ~ S ~~ d ~'`,
PHONE #: Home ( ) Work ( ) ~- Cell ( ) ~ /,~ ~~.~ Z ~
OWNER MAILING ADDRESS: ~S~ ~ 3~ d t,J CITY: °e C bu/' TATE:~ZIP: ~~ D
EMAIL
FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing
APPLICANT INFORMATION: ADDRESS
STATE; ZIP
PHONE #: Home
EMAIL
Work
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work#
FAX
to act as agent for owner must accompany this application.)
CITY:
FAX
Cell ( )
CITY STATE ZIP_
Cell#
How many buildings are located on this property?
Did you recently p~u~rchase this property?
Is this a lot split~_~' YES (Please >~
No Yes (If yes give owner's name),
PROPOSED USE: ~~ v~2Fj~ ~
(i.e., Single Family Residence, Multi Family, Apar
copy of new legal description of property)
-nts,~P'emod ,Garage, ommercial, 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-menf ned property for i ections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions of the 2~~International Co in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permi~ approv as based. Permi oid if not started within 180 days. Permit void if work stops for 180 days.
ig re'' f Owner/Ap 'cant DATE
Do you prefer to be contacted by fax, email o pho e? Circle One
WARNING -BUILDING PE T 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**
PERMIT #
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
Please complete the e~ire Application! ~
/ If the question does not apply fill in NA for non applicable
NAME ~G 1r~1~-r~ t~ ,P~ 2 ~~m ~'- ~
PROPERTY ADDRESS '~ Z S S °~~ d c,/ Permit#
SUBDIVISION
Dwelling Units: Parcel Acres: r Z ~{
SETBACKS
FRONT SIDE SIDE BACK
Remodeli g Your Building ome (need Estimat) $ f ~? ~ 5
SURFACE SQUARE FOO AGE: (Shall include the exterior wall measurements of the building)
First Floor Area ~~ Unfinished Basement area
Second floor/loft area Finished basement area
Third floor/loft area
Shed or Barn
30" above
Water Meter Count:
Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name: Business Name:
Address City State
Contact 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 $
(Commercial Only)
Garage area
Business Phone:
Fax
Sprinklers
Tub/Showers
Toilet/Urinal
Water Heater
Water Softener
Zip
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
Please com lete the ent~ A lication! if the uestion does not a 1 fill in NA for non
A PA 9 PP Y
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address
Contact Phone: ( )
Email
City
Business Name:
State
Business Phone:
Fax
Zip.
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The
CHANICAL
License number
's permit fee schedule is the same as
Date
the State ofidaho
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete: ~p~~t ~'/ t S~ ~ ~ ~.,,~ ~ ~ ~ ~~ -
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:_
Siding/Exterior Trim:
Other: