HomeMy WebLinkAboutAPPLICATIONS, MULT DOCS - 05-00267 - 369 Eagle Ct - Water MeterC'~rY OF REXB URG PERMIT #
BUILDING PERMIT APPLIC~ION Please complete~e 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: tGCtti lC~ru'Du ~ UNIT# BLOCK# LOT#
(Addressing is based on th information -must be accurate)
c
PROPERTY ADDRESS:
PHONE #: Home
Work
CONTACT PHONE # ~ ,~- ~ - ~ ~ 9,t'
Cell
OWNER MAILING ADDRESS:.3~ ~ ~Q ~ !~ ~l~ CITY: ~Gsc.~-~ STATE~~C.ZIP:~~f/~?
EMAIL FAX ~~ (,/~ ~,,+~~ `~,c~
APPLICANT (If other than owner) `~~% c~ G. ,--~ ~°~
(Applicant if other than owner, a statement authorizing applicant to act as gent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 3~i ~ .~~ ~~ ~~
STATE; .~~ ZIP ~ `!b EMAIL
PHONE #: Home ~ ~S ~- ~~-y3`Work
CITY:
FAX
~ > L - ~> >' ~ Cell ( ) 3 .S"! - ~ ~"9 3=-
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? pV-~ N {--
Did you recently purchase this property? No Yes (If yes give owner's name) ~ u
Is this a lot split? NO YES (Please bring copy of new legal derrscription of property)
PROPOSED USE: ~~~ Li ti v L Gt~~ L~ ~~ .~ `~ ~~ J'O ~~ _ 6 ~ ~ ~'~~/ G G~cry 1~ ~Q d°<! v
(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 herea8er 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 for 180 days.
Signature of Owner/App ' ant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plau 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 th~tire Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units:
SETBACKS
FRONT
4 Parcel Acres:
SIDE
SIDE BACK
Remodeling Your Building/Home (need Estimate) $
Unfinished Basement area
Finished basement area
Garage area
Carport/Deck (30" above g
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
)Area
Water Meter Count: ~-
/ ~~
Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name:
Address
City
Business Phone:
Fax
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)
Signature of Licensed Contractor
The City of Rexburg's
Permit#
Sprinklers
Tub/Showers
Toilet/IJrinal
Water Heater
Water Softener
License number Date
e schedule is the same as required by the State of Idaho
Business Name:
State
Zip
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