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HomeMy WebLinkAboutAPPLICATIONS & PLAN - 05-00259 - Upper Valley Resource & Counseling - RemodelJ CITY OF REXB U ~ PE BUILDING PERMIT f LIGATION Please com e e 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: ~ pss %~K~1 !/V)4~a ~wieN't CONTACT PHONE # ~3/7-G(o0o 359-p57~ PROPERTY AD RESS: G, ti w~ l~ ~@ ~ PHONE #: Home ( ) 3.SG -~r a~ Work ( ) 3 $~-b S ! ~ ell ( ) ~ l 7 - ~ (n 4D OWNER MAILING ADDRESS: ,3(oN o?~ W CITY: STATE:~~ ZIP: S'jYyj EMAIL u V -^CG~Sv~v~ h~f FAX 35~ - a-~9~ APPLICANT: (If other than owner) SG ~. ~ (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS STATE; ZIP PHONE #: Home ( ) EMAIL Work Cell CONTRACTOR: Sa.Nt e MAILING ADDRESS: CITY STATE ZIP PHONE: Home# Work# Cell# EMAIL FAX How many buildings are located nn this nrnnerty? 1 Did you recently purchase this property? ~ 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: (, ©yv~n,~>° ~ c i a. ~ ~ ~~~~ ~,-~-~-'''-' (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Co rcial, 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 corcect 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 fQr 180 dayS~ ~ ~. of Owner/ x-10 ~''~ 1~ywt ti S DATE Do yoll prefer to be cd'ntacted 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 CITY: FAX 3 **Building Permit F are due at time of application** **Building P~s are void if you check does not clear** Please compl ~e entire Application! ~If the uestion does not a 1 fill i q pp y n NA for non apphcable NAME PROPERTY ADDRESS SUBDIVISION Dwelling Units: SETBACKS FRONT Parcel Acres: SIDE SIDE BACK Permit# Remodeling Your Building/Home (need Estimate) $ y,sol~ 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 Carport/Deck (30" above g Water Meter Count: Fax Required!!! PLUMBING Plumbing Contractor's Name: (~r,~ n ~ --- ' y ~ 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 $ (Commercial Only) Required! Signature of Licensed Contractor License number The City of Rexburg's permit fee schedule is the same as Date by the State of Idaho Water Meter Size: State Zip Sprinklers Tub/Showers Toilet/LJrinal Water Heater Water Softener D 4 Please complete ~ntire Application! If the does not apply fill in NA for non applicable NAME PROPERTY ADDRESS Permit# SUBDIVISION Required!!! MECHANICAL Mechanical Contractor's Name: ~~,~ ~ ~ Business Name: Address City State Contact Phone: ( ) Email Business Phone: Fax 1 Zip Mechanical Estimate $ ~ ol,~ (CommerciaUMulti Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas-fired appliance Incinerator System Boiler Pool Heater Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: ~~ 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 License number Required! The City of Rexburg's permit fee schedule is the same as the State of Idaho Date 5