HomeMy WebLinkAboutAPPLICATIONS, BP - 05-00371 - 20 E Sunset Cir - ShedF
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C~-~'Y OF REXB U~ ~ PE #
lease Comte the entire A lication!
P PP
0 5 0 0 3 71 the question does not apply fill in NA R E Ci E PV E~ile
Shed - 20 Sunset Cir (we will provide this for you) OCT _ 5 2005
SUBDIVISION: UNIT# BLOCK# CITILO~F~REXBURG
(Addressing is based on the information -must be accurate)
CONTACT PHONE # ~ 1- "la-~ ~-
PROPERTY ADDRESS: a0 ~ Su~15>/T (~e.~l~
PHONE #: Home (~~) 356 - big Work (a.o~) 35~.-1a~ ~-- Cell ~.v~ 35l ~ '1 ~ ~
OWNER MAILING ADDRESS• Sf~-r~~- CITY:~ic~iu,~' STATE:~1 _ZIP:~~
EMAIL ~,c.K.a® EwS~1NC,Coa~'~ ~~-3cj~ `~l-l~
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 FAX.
PHONE #: Home ( ) Work
Cell
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 copy of new legal description of property)
PROPOSED USE: SI~~'D •~u t_t~ '3~u.~.{'
(i.e., Single Family Residence, Multi Family, Apall(ments, 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
provisio s 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
permi approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
/~/
Signature of Owner/Applic t DA E
Do you prefer to be contacted by fax, email phone? ircle One
WARNING -BUILDING PE ST 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**
~ a i A..~J 11J~1 ~.`~.~i ~s?i ~ i, t ~~r'~~ ~'JVro ,'Y~i~d!~~, L~I~'~~'i~~ £~`~i flf'ih~ ~ rt ~~91
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. .... ~ . ~. .. ,.. :..:, .r ~ .. ~., ...mot-.
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AMERICA'S FAMILY COMMUNITY 19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg,ldaho 83440 Fax:208-359-3024
www.rexburg.oro comdev@rexbur~ora
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 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 day of , 20
Signature
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
Please complet~he e~ire Application! ~ ~
If the uestion does not apply fill in NA for non applicable
NAME ~t G{~t~~ ~ hir ~ e~5 o tit
PROPERTY ADDRESS w >~ S2T Permit#
SUBDIVISION'-['QU t n-~"
Dwelling Units: 4 Parcel Acres:
SETBACKS
FRONT SIDE ~ Z. 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 a~y
(30" above grade)Area
Water Meter Count:
Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name:
~~
Address
Contact Phone: ( )
Email
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
Unfinished Basement area
Finished basement area
Garage area
BACK
Business Name:
City
Business Phone:
Fax
State
Zip.
Sprinklers
Tub/Showers
Toilet/CJrinal
Water Heater
Water Softener
(Commercial Only)
Signature of Licensed Contractor
The City of Rexburg's
License number Date
e schedule is the same as required by the State of Idaho
' Please complete ~ enti~ Application! If the qu~n doe~t apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required!!! ~,~
Mechanical Contractor's Name:
Address
Contact Phone: ( )
Email
~ Mechanical Estimate $
(Commerciall'Multi Family Only)
FIXTURES & APPLIANCES 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
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Space Heater
Unit Heater
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
State
Zip
Signature of Licensed Contractor License number Date
Required!
MECHANICAL
Business Name:
_City
Business Phone:
Fax
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
5
. •
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other: