HomeMy WebLinkAboutAPPLICATION - 05-00256 - 234 Cornell Ave - Plumbing~.a,
CITY OF REXB URG ~ PERMIT # ~
BUILDING 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: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
OWNER: CONTACT PHONE # ,f~,~y; 6 -x91.6
PROPERTY ADDRESS: ~c~d- ~1~Q, ~~~~ ~ ~ 3~ ~er rl r jl
PHONE #: Home (~~) yr,~;o X916 Work (~) A~~ _~g~ cwt Cell ( ) ia5~ - oo~S'-
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STA
PHONE #: Home
CITY:
ZIP EMAIL
FAX
Work ( ) Cell ( )
CONTRACTOR: Gr_,S lI G'Y' {~ ji~d ~'
MAILING ADDRESS: ~y3 ~~,,Cl. 1/S t~. f CITY T2(~~ JJ< STATE ~~Q. ZIPL
PHONE: Home#
EMAIL
Work# _s~ g =S"~~ 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 pemut 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 ~ppproval 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 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**
i /
-'Plea ~
se complete the enti>~Ap hcation.
p
If the question does not apply fill in NA for non applicable
NAME __~ ~ ~
PROPERTY ADDRES S ~~ ~, r ~ /~ 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
Parcel Acres:
Unfinished Basement area
Finished basement area
Garage area
(30" above grade)Area
Water Meter Count:
Water Meter Size:
Required!!!
PL UMBING
Plumbing Contractor's Name: ~~~5~// /~~ r~l,~ Business Name: ~~~Iy",~~~.,~,
~--
Address~ 3c~~ ~~~~ City Z„ ~; State~~1, Zip 3y~/
Contact Phone: (~~) ~ ~~~~ Business Phone: ( ) s
Email
FIXTURE COUNT (including roughed frxtures)
r Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
~_ Sinks
(Lavatories, kitchens, bar, mop)
Fax
Sprinklers
Tub/Showers
Toilet/LTrinal
-,--
Water Heater
Water Softener
Plumbin Estimate $ (Commercial Only)
Signature of Licensed Contractor
The City of Rexburg s p
License number
e schedule is the same as
to
by the State ofldaho