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Home My WebLink AboutALL DOCS - 05-00315 - Child Resource Center - Site PlanCITE' OF REXB URr' PE ~ T # BUILDING PERMIT ~LICATION Please com to 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~~V~ 1~'2,C0\~ (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) OWNER: / CONTACT PHONE PROPERTY ADDRESS: ~l h ~®~~~ ~ ~ ~'~'~f ~~~~'eG lam' $3 ~~~ PHONE #: Home ( ) ~;.j.~- 7l7.Z Work ( ) 33 6 - 4~Q1~ Cell ( ) aS! ~~'9l/ OWNER MAILING ADDRESS: ~S©~ ~ /'?~,'~~`~ CITY: ~E~~~ STATE: <D ZIP: 3~`~`4~~ EMAIL /2~ ~~Ctf2 a~ AQC,cO~ FAX 3.5~ - S©ff 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 STATE; PHONE #: Home Work FAX Cell ( ) CONTRACTOR: MAILING ADDRESS: CITY STATE ZIP PHONE: Home# Work# Cell# EMAIL FAX u,. , L., ;l.l;,,rto orA lnr~atarl nn this nrnnPrty~ di7'~ ,v~~. £ Qaf SEy'~D i iv yr uiuu~ v.,.~.......b., ...~~ _,. _-'---' --- ----- r- -i ~ Did you recently purchase this property? No Yes (If yes give owner's name) ~p~lRL.7 drt ~~£~ Is this a lot split NO YES (Please bring copy of new legal description of property) PROPOSED USE: r~<~ ~'~~~ls~Gl~~ ~ ~~~Ad!~ - ~o~ (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage ommercial ddition, 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 18 days. -^ Signature of Owner/Applicant 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 Rezburg's Acceptance of the plan review fee does not constitute plan approval CITY: ZIP EMAIL r~ n cQ N ~ n-i-a~ ~ K K N v 3~~"0 ~ ~.,c =. Z ~ ~ ~ ~ C9 ~ W. ~ . ~ O v c'D G fD B ~ O ~p O G ( Q. O ~ O_ `z ' N C co f7 fD fD .. .. .. C ~? c cn fD (D 7 .. .. ,..r ~< 0~0 N° N W~~ A O O A A OND m A~ m 'p O '~ r~~ W ~~ v O~ ~° C~ N W v X~ C ~ w~° mc°~ on rn~ ~ ~ ~~ O rO~~oO O N ° ~ W Q~ ~omO~ CSC. p° ZN h ~ TAW N r ° Oo W ~ O O ~ O • ~ W , QO Ill N .~ G S?o C7 mm cn