HomeMy WebLinkAboutAPPLICATION - 05-00271 - Rexburg LDS Temple - StructureCITY 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: ~~1,~' l~ v/' t /t1cIS cl3~lf7" ~r~=L l~ CONTACT PHONE #
PROPERTY ADDRESS: ~~r ~~U~ ova ~=,~-,/ j
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT: (If other than owner) ~~~ ~F tE~i% r~= ~/~/-~/TfCj7/jd/~L /~,/~-~C~ ,l,~/~"
(Applicant if other than owner, a statement authorizing a plicant to act as agent for bwner must accompany this application
APPLICANT INFORMATION: ADDRESS /~s"~ /~'/p4-i// CITY: fn~~gi~~ C17~
STATE, ~~'1 ~ ZIP ~ ~~ EMAIL I31~F'~~fC~,~ItGN,~X<iJ `~`~ F~ ~~~5- '7S~ - ~/~Q
PHONE #: Home ( ) Work ~~ ~S~ -;~~4 / Cell ~~' ~7~ - y~~r
CONTRACTOR: c~AfiC~lFJ/ Ca~Zrf'~fi 7~ / (ter
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
riow many bulld>ngs are located on this property`I
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: ~~T~7LIa~2 5;~~,~/ ~' ~fIGTI//l.~L ~T~~ ~~~f~M
(i.e., Single Family Residence, Mult'f'Family, Apartments, Remodel, Garage, Commercial, di ion, 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 permit or approval was based. Permit void if not started within 180 days. Permit void if work
stops for 180 days.
of
/~/ ~~
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
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