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Home My WebLink AboutBP & APPLICATION - 05-00277 - 387 N Airport Rd #28 - Mobile HomeZ rn ._ w s o m c °c '~ ~vo. ~ .. a ov o ~ ~ ~ N 7 "' c0 A y m m n n m 0 0 m v m 3 m N a i f0 0 c v c 3 Q F 0 N S O N d a ~ v > >' o j ~ ~ C O ~ N N Q x ~ Z CC7 t0 ~ C1 ~? ~ N a m. o m f " ~ ~- o o c ~ F N N N (D N -~ ~ ~ oSi v ~ °. v .~ O' ~ ~ . K ~ o f 4 m ~~d ~oo~o m' ~ a a = v s~,~~ ~ ~ o~ ~ W~ ~ '~ ~ ' ~ ~ o, = . ~ ~ ~ ~ y xN ~. ~ ~~_ .~ ~~ y Q- C ~ ~ O ~ C ~ ~ n ~~ ~ ~ ~ ~ ~ ~ ~ ~' ~ rn ~~`~~ ~ N (') ~ ? v° ~ c.~ O O N ~ C ~_ ~ O O O 3 p ,0. Q °' Z o H ~ Vl S y ~ y ~ O O ~ 7 r W ~ N ~ "'~ =.n ~3 ~ ~~~ o _ . 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W N T ~ ~ ~ m °' ~ a ~ c ~ ~ a ? ~ ~ _ m C n 7 7 S • . ~ ~ N O ~ ~ 0 T ~ CO OD V 01 CJ1 A W N -n w ~ ~ ~ n cn rn v ~ v '~ = ~ ~ o ~ T °~ ~ ~ °c m o -n ° ~ r o d 3 `~ C~'1'F~' 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: ~P'~Cg~.A ~~-~ (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# ``~ (Addressing is based on the information -must be accurate) ` OWNER ~ //yl(,e~' CONTACT PHONE #~~~~3~ PROPERTY ADDRESS: ~ ~'~ ~~ ~YDao~r~ (~ ~~~' ~~*e~c~kr~ ~~ PHONE #: Home (~~'35G'- ~~ Work ( ) Cell ( ) ~~- ~/~~~ OWNER MAILING ADDRESS: , f1 ,SQ,~ ~/~ CITY:1~~ ~ STATE•~ ZIP: ~ 3 ~~z 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 CITY: STATE; ZIP EMAIL PHONE #: Home ( ) Work Cell FAX CONTRACTOR: MAILING ADDRESS: CITY STATE ZIP PHONE: Home# Work# Cell# EMAIL 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 dopy of new legal doescription of property) PROPOSED USE: S~-~ ~' ~-~ ~~1- ~. /~ ~-~s J` \ CSC (i.e., Single Family Residence, Multi Family, Apartme s, 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 permit on approval issued under the prov 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 pe it o approval was based.,,Permit void if not started within 180 days. Permit void if work stops for 180 days. ~~ ~, DSr 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** ~ CI~OF• R~:xBUR~ ~ AMERICAS FAMILY COMMUNITY • • Affidavit of Legal Interest State of Idaho County of Madison I, Name Address City State Being first duly sworn upon oath, depose and say: A. (If Applicant is also Owner of Record, skip to B) That I am the record owner of the property described permission to: Name Address to submit the accompanying application pertaining tot t property. B. I agree to indemnify, defend and hold Rexb g City and its employees harmless from any claim or liability resulting from any disput 'as to the statements contained herein or as to the ownership of the property which is t subject of the application. Dated this day of , 20 Signature Subscribed and sworn to b~f`ore me the day and year first above written. Notary Public of Idaho Residing at: the attached, and I grant my My commission expires: ' Please complete th~en~e Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION Dwelling Units: Parcel Acres: SETBACKS FRONT SIDE SIDE 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 Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area Water Meter Count: BACK Water Meter Size: Required!!! PLUMBING Plumbing Contractor's Name: ,~c~l 7 Business Name: Address City Contact Phone: ( ) Business Phone: ( ) Email Fax FIXTURE COUNT (including roughed fixtures) Clothes Washing Machine Sprinklers Dishwasher Tub/Showers Floor Drain Toilet/LJrinal Garbage Disposal Water Heater Hot Tub/Spa Water Softener Sinks (Lavatories, kitchens, bar, mop) ~ Plumbing Estimate $ (Commercial Only) Permit# 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 State Zip, Please complete the ~ir~pplication! If the questio>~es .apply fill in NA for non applicable NAME PROPERTY ADDRESS Permit# SUBDIVISION Required!!! Mechanical Contractor's Name: Address Contact Phone: ( ) Email Mechanical Estimate $ MECHANICAL Business Phone: Fax Business Name: City State (Commercial/Multi Family Only) FIXTURES & APPLL9NCES COUNT (Single Family Dwelling Only) Air Conditioner Bath Fan Vents Range Hood Vents Boiler Cook Stove Vents Decorative Gas Fireplaces Dryer Vents Evaporative Cooler Exhaust or vent ducts Fuel (gas) piping fixtures or appliance outlets Furnace Furnace/Air Conditioner Combo Heat Pump Incinerator Pool Heater Zip Space Heater Unit Heater Heat (Circle all that apply) Gas it 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 Date Required! The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 5 y. SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: ~~,~ ~~ Heating: Electrical: ,~-4,P.~.c f~ !~/r-~~ 5 Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: Siding/Exterior Trim: Other: