HomeMy WebLinkAboutAPPLICATIONS - 05-00294 - Walmart Photo Lab - Remodel
CITY OF REXBURG
PERMIT #
•
BUILDING PERMIT APPLICATION Please complete the entire Application)
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA far 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: ,~ ~'•,-„'t, ~5 +~-,~ ~ ``f a+ ~ CONTACT PHONE # y ~~ ~ - tic ~ - ~3i CF ~ ~
~lon.~y tYa~r
PROPERTY ADDRESS: wa 1-- ,E~Qr -r '1 :~ ~ N ,, ,~ ;;. ~, ~ ~~ ~ ~ c~ y -i- w' ~ x ~ ~ ~ ,^ n
PHONE #: Home ( ) ,~ (Q Work ( ) „ ~ 2 Cell ( ) n la
OWNER MAILING ADDRESS: ~ G ~; ~ s e , , ~~ , ~+ . CITY::,,+G„ , . ~ ; p STATE: R c~ ZIP: 't ~: ~ ; t<,
EMAIL
APPLICANT: (If other than owner)
(Applicant if other than owner, a statement authorizing appli
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMA
OS 00294
Wahnart Remodel Photo Lab
PHONE #: Home ( ) Work ( ) Cell ( ) ` ~ ~~''e,
~L ~G
CONTRACTOR: ~~ 1,
MAILING ADDRESS:
CITY
ST
PHONE: Home# Work# Cell#
EMAIL
FAX
How many buildings are located on this property? f
Did you recently purchase this property. No Yes (If yes give owner's name)
Is this a lot sp1i~N~. YES (Please bring copy of new legal description of property)
PROPOSED USE: C ~ ~ ;~ ~ r c ; ~ i - ~.. ~ c ~ a~ P h - ~ I h ~ ~~ ( ~- r - ;r-~+-r I ~
(i.e., Single Family Residence, Multi Family, Apartments, Re del, Garage, Commercial, Addition, Etc.) `]rU S ~
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of penury, 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 heazings 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 off ial may revoke a permit on approval issued under the provisions of the 2000 International Code in cases of any false statement or
misrepresentation of fac~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
stop,yPb} 180 days. //
~-~i Z~.f
DATE
you ?(irefer 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
ZIP
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~f~CY CAF ~.# ,
~.
AA~iERICAS F.IMILY CC?MMUI~I'fY 19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www.rexbura.ora comdev cC~rexbura.orp
Affidavit of Legal Interest
State of Idaho
County of Madison
I,~'ennv ~lA2p on [3~1+.a~~ D rt` , ADO/ S+L~. /p~~'' S~R•tc-t"
Name G~y,4~_iNA~~ I~iAl6~Sfi4H~ f3tti • T/'v~Address
~•~rr ~ ~ ( ~ IeK.fs~t to S
City State
Being first duly sworn upon oath, depose and say: ~~~,
(If Applicant is also Owner of Record, skip to B) ,q~ ~' `^' ''`~...
A. That I am the record owner of the property described on the att ~~ d, and ~~a~t my "~ ~ ~"
permission to: ~~~'~
Name Address ` `
to submit the accompanying application pertaining to that property.
'~',~
(~ I agree to indemnify, defend and hold Rexburg City and its employees harmless fro any
claim or liability resulting from any dispute as to the statements contained herin or as to
the ownership of the property which is the subject of the application.
Dated this $ ~ day of /4 Lta uS~ , 20~
~ ~c ,~ o W Atl -tvt.H~ >f'
gnature ~ q~/ /t 3 {+I ~ I~j K f~k / f f r/'q
Subscribed and sworn to before me the day and year first above written.
"NOTARY SEAL"
Vicki Flippo, Notary Public
Benton County, State of Arkansas
My Commission Expires Nov. 1, 2012.
n
,~ ,
4 ~~
Notary Public of~ke-q /KA A
Residing at: ~L.-~`~ ~O
My commission expires: ~ ~ - ~ ~ ~ ~-~~ ~
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' **Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
Please complete the entire Application!
If the question does not apply fill in ~'SA t'or non applicable
NAME c-L~+- fyt~.,~ -w
PROPERTY ADDRESS .~ ~ ~:~ N~r~- -, ~~,~t C ~ --' Permit#
SUBDIVISION
Dwelling Units: n f ~ Patcel Acres:
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building/Home (need Estimate) $ ~ D ®C~
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement area ~ I ~
Second floor/loft area „ 1~. Finished basement area n ~ cam.
Third floor/loft area n. i~ Garage area n f ~
Shed or Barn .~ i c.2., Carport/Deck (30" above grade)Area n ~
Water Meter Count: ~ 1 ~
Water Meter Size: C x , g+ ; „ ~:
Required r I r
PLUMBING +~ o~ ~~~r~c~~
Plumbing Contractor's Name:
Address City
Contact Phone: ( ) Business Phone:
Email Fax
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine
Dishwasher
_~ Floor Drain
Garbage Disposal
Hot Tub/Spa
~_ Sinks
~i (Lavatories, kitchens, bar, mop)
State Zip
Sprinklers
Tub/Showers
Toilet/Urinal
~ Water Heater
Water Softener
Plumbing Estimate $ (Commercial Only)
I2ec~~iiredi Si~nanire of Licensed. Contractor License, number
The City of Rexburg's permit fee schedule is the same as
Date
by the State of Idaho
Business Name:
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' Please complete the entire Application! If the question does not apply till in NA for noTt
~Ypplirable
NAME c_.r.~~. i- Mck;^ 7-
PROPERTY ADDRESS ~':~ ~: N ~ r~+ 5 ,~ n ~ £' ~-~ 7 Permit#
SUBDIVISION
~2equi~ed!!! MECHANICAL
Mechanical Contractor's Name:
Address
Contact Phone: ( )
Email
Business Name:
_City State
Business Phone:
Fax
Zip
~ Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
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 cif Lice~i.sed ~,orltl'aclCSr
Required?
The City ofRexburg's
Leen~e r~u~nber
schedule is the same as
Date
by the State of Idaho
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SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings:
Plumbing:
Heating:
'i' p t'l f ~.:.~ d. r ~` P ~~
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim: n
Other:
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