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HomeMy WebLinkAboutAPPLICATION - 05-00354 - LDS Church - Water Meter/Lawn SprinklerCITY OF REXB URG ~ PERMIT # BUILDING PERMIT APPLICATION Please complete th~entire Application! 19 E MAIN, REXBURG, ID. 83440 If the ques*inn .~no~ not ~nrly fin in NA fnr nnn annlinahln 208-359-3020 X322 PARCEL NUMBER: ~+`P~Z'~ X ~ ~ C) ~ ~ ~/ 1~.~(' ®~ Q ~ 3 54 suBDIV1S10N: ~ S rinkler & Water Meter (Addressing is based on the information -must be accurate) p OWNER (; ~ CONTACT PHONE # PROPERTY ADDRESS: ~ ~~ ~ `~-~( k/@~~ ~-~" ~©~~ PHONE #: Home ( ) Work ( ) Cell ( ) OWNER MAILING ADDRESS: CITY: STATE: ZIP: 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 STATE; ZIP PHONE #: Home CITY: EMAIL Work ( ) Cell FAX CONTRACTOR: ~ ~ ,--~ MAILING ADDRESS:~~O ~ .~g(~ Sp~ CITY STATE T~ZIP~ PHONE: Home# - Work# 3~6 ~-3s',~ ~.-Cell# 3 ~ 1-- g~0 ~ EMAIL~Gp~ S ~ 1 ~ rn .- ~Pi~-' FAX ~ S,~ ` ~ ~ ~° How many buildings are located on this property? ~ Did you recently purchase this property?' Yes (If yes give owner's name) Is this a lot split? T~O YES (Please bring copy of new legal description of property) PROPOSED USE: "~~''c~-r ~~".~,~ /I~ +- -~~~ ~e ~ P~~'~ol~'!.r- ~~I~r_ (i.e., Single Family Residence, Multi amity, 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 sweaz 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 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 stopFrlb~ 180 days. /J 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 Rexburg's Acceptance of the plan review fee does not constitute plan approval **Building Permit Fees are du t time of application** **Building Permits are void if you check does not clear** Please complete the ere 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 BACK Remodeling Your Building/Home (need Estimate) $ State Zip ', 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 (30" above grade)Area Water Meter Count: ,~ Water Meter Size: ~ ~'' Required i ~ r PLUMBING Plumbing Contractor's Name: Address Contact Phone: ( ) Email City Business Phone: Fax 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) Required! Signature of Licensed Contractor The City of Rexburg's ~_ Sprinklers Tub/Showers Toilet/LTrinal Water Heater Water Softener Permit# License number Date schedule is the same as required by the State of Idaho Business Name: 4