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Home My WebLink AboutAPPLICATIONS, BP - 05-00359 - 351 E 3rd S - ShedZ Q C7 rn .~. W N G7 ~ O n N N .O =a~ m n n ~ $ ~ a-• g~~~. ~~~~ c ~ ~ ~ o c 3 v ~ 7 (D = ~, •.• n D7 O d o 1 ~ N a 3 a c 0 3 ~ _~ < ~ ~ ~. F °. o w x ~ N D_ ~ N ~_ < Q d n°~ p a ~~ a~ ~ -o ~ ~ o ~ o ~ ~ F ~ _ o ~ N N O. F ~ Z n (D S O O ~ 6 ~_ 7 .y.. N .C O' Q C N O fD n W O. 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W N N r^ n ° m S N ~ 5 u T ~ ~ ~ '0 m , w ~ U1 ~ ~ ~ 7 5 N o = ~ m ~ n T ~ ~ m "'~ ~m m -o v~ S ~ Cn 3~m ~ `~ ~ Q ~ ~ Z v Z O~ OT v ~ Z ~ ~ C ~ C ~ o ~ ~ ~~~ o n 3 r w z~c~i ~ ' a W ~ p yT~ ~° ~ ~ Z z Z ~ ~Z w -~, ~ D D n~Z N 7'~ O w ~ w ~ m n ° c rF ~ co n ~ Z n ~ Q -a g ~ in ~ ~ N n Z O < < ~ ~ 'i a a CO U1 ? W N --~ ~t j ~ S N ~ ~• ~ ~ ~ c N °o~ fQ O ~ o CITY OF REXB URG ~ PERMIT # BUILDING PERMIT APPLICATION Please complete the entire Application! 19 E MAIN, REXBURG, ID. 83440 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) NAME: S' ~ ~ ~. '~,r{d„~ lrJ CONTACT PHONE # 3~(p - nil y r PROPERTY ADDRESS: 3 J I L ~,~ ~' ,3'^7O ~fly~ ~Q~,Lj~,b PHONE #: Home (Z~op) 3 ~' ~o - spy ~~ ~ Work (Z~) 3~ ~O - 7 ~ b ~ Cell ( ) OWNER MAILING ADDRESS: CITY: 6 STATE:.~D ZIP: O ~yy O 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 If the question does not apply fill in NA for non applicable 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?~~ Yes (If yes give owner's name) Is this a lot split?~ YES (Please bring copy of new legal description of property) PROPOSED USE: S~ ~ ~c`,~Q~~ 5~~' ~ (i.e., Single Family Residence, Multi Family, 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 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 wpai)~s~ed. Permit void if not started within 180 days. Permit void if work stops for 180 days. ~~~~ p~~ Signature of Owner/Applicant D TE Do you prefer to be contacted by fax, email o phone . Circle One WARNING -BUILDING PE UST 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 **Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear** ~~ C1TY QF ~~ ~~. •. AMERICA'S FAMILY COMMUNI`fY __ _ .~ Affidavit of Legal Interest State of Idaho Count(y`of Madison I, ~ 1 ~ ,n ~. ~~(tOvJrl ~ J ~ ~~ ~ 3 `~ ~y~ Name Address City Being first duly sworn upon oath, depose and say: ~-~ State (If Applicant is also Owner of Record, skip to B) A. That I am the record owner of the property described on the attached, and I grant my permission to: Name Address to submit the accompanying application pertaining to that property. B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any claim or liability resulting from any dispute as to the statements contained herein or as to the ownership of the property which is the subject of the application. Dated this I ~ Signature day of .~ ~.~, , 20 d~~ Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: If the question does not apply fill in NA for non applicable NAME ~ ~ ~, ~p PROPERTY ADDRESS = Y'd'~ Permit# SUBDIVISION Dwelling Units: ~ Parcel Acres: SETBACKS ~ FRONT ~7S ~ SIDE ~''O l -~- SIDE ~~' ~ } BACK ,3 ~ } 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 ~ ~p Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above g Water Meter Quantity: ************** Water Meter Size: Required!!! 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 $ State Zip Sprinklers Tub/Showers Toilet/tJrinal Water Heater Water Softener (Commercial Only) ~ I~ Business Name: 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 ~`ICaSe COrilp~ete t~1C eritl App~1Cat10ril If the question does not apply fill in NA for non applicable NAME ~ •~ ~ ~ ~ /Y~Y'~ PROPERTY ADDRESS ~' "4 Permit# SUBDIVISION Required!!! MECHANICAL ~' Mechanical Contractor's Name: Business Name: Address City Contact Phone: ( ) Business Phone: ( ) Email Fax Mechanical Estimate $ (CommerciaUMulti Family Only) FLKTURES & APPLL4NCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater 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 Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: 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 of Licensed Contractor The License number State Zip Date 's permit fee schedule is the same as required by the State of Idaho