HomeMy WebLinkAboutBP & APPLICATION - 05-00396 - 16 Sunset Cir - ShedZ
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CITY OF REXB URG • PERMIT #
BUILDING PERMIT APPLICATION Please c
208-359- 020 X3 BURG, ID. 83440 If the ques ®5 00396
PARCEL NUMBER: T~~1~,~Y~~ ~ ;~ti°° (v~ Storage Shed -Hobby Space
SUBDIVISION: _1 cz ~ ~ Y' UNIT# BLOCK#~LOT#~
(Addressing is based on the idformation -must be accurate)
OWNER: ,~ ,. C'~ ~~~ dd~~ `I~ ~ r t~_CONTACT PHONE #~d
PROPERTY ADDRESS: /~ ~ ~ ~~( 17 ~ C? ~ ~' l V`C~
PHONE #: Home (Zak) ~ ~~' - n~ Work ( ) /~~- Cell ( ) /V~}
OWNER MAILING ADDRESS: ~'l~ ~ ~~t~]Se7'('r ; CITY: ~Gi 1'~ STATE:~ZIP: ~' ~~51~
II ~ ~ ~ ~~ ~~
EMAIL r2% d ~ ~ ~- e 1l/~a~~' FAX
APPLICANT (If other than owner) /~,/ /f
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE; ZIP EMAIL
PHONE #: Home ( )
CITY:
FAX
Work ( )
Cell
CONTRACTOR: j ~ f ..~
MAILING ADDRESS: /C~~ S ~ ~I s ? 3 ~ ~ rc l~~ CITY ~ '_, ~' ~' l % STATE ~~' ZIP ~ ~~' ~'~=1
PHONE: Home# ~-~ ~ ' ~r'~~' Work#
~`> _~
EMAIL '' :~ ° ~ b' e-,~~,_ ~ w,~?-' ~~ FAX
.''~ "~ Cell#
,~~_
How many buildings are located on this property? (~' /~~ ~ C r, ~ ~ vE
Did you recently p/~'chase this propert~~o ~ Yes (If yes give owner's name) /V
Is this a lot split? NO % YES (Please bring cop of ew legal description of property) ~~Z~dS
PROPOSED USE: -..% ~~Tt~ r a9 ~ ~ !~ r ~ _ ~ 4 ~ ~ `-9 ~ Pa- ~ ~~ ~~ ~~fB~)RG
(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 herea8er 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 baAecj. Permit void if n~ started within 180 days. Permit voice work stops for 180 days.
Signature of Owner/Ap
DATE
Do you prefer to be contacted by fax, email o phone . Circle One
WARNING -BUILDING PEST 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**
•
R.EXBLI~~
s AMERICA'S FAMILY COMMUt~+ll'CY 19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg,ldaho 83440 Fax:208-359-3024
www.rexburq.or9 comdev rexburg.ora
Affidavit of Legal Interest
State of Idaho
County of Madison
I, rte. a ~~~ rta ,
Name
~.~\ ~ ~~ ,
City
f /
Address
Z~'~ ~ c~
State
Being first duly sworn upon oath, depose and say:
(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 /~ ~ day of ~ ~ ~ {~ , 20 ~~ ~
Subscribed and sworn to before me the day and year first above written.
r
Notary ublic of I o
Residing at:
~ ~ My commission expires: ~~~ ~ ~ D~
Please complete the ~tire Application! ~
If he question does not apply fill in NA for non applicable
NAME o ~
PROPERTY ADDRESS ~ ~ ~ ~t ~~~~ Permit#
SUBDIVISION a.
Dwelling Units: ~ Parcel Acres: ~~Z. ;
SETBACKS
FRONT ~ ~`~-~~ -~- SIDE ? r ~ SIDE ~' BACK
Remodeling Your Building/Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area ~/ /4- ~. ~ ~-,Unfinished Basement area N
Second floor/loft area /~!/-~- Finished basement area
Third floor/loft area ~ Garage area
Shed or Barn "~' ~ _ '° , r' ~' ~ ~'Carport/Deck (30" above grade)Area
Water Meter Count: ~,/~ Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name: /~ Business Name:
Address
Contact Phone: ( )
Email
FIXTURE COUNT (including roughed frxtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $ (Commercial Only)
Sprinklers
Tub/Showers
Toilet/Urinal
Water Heater
Water Softener
City State.
Business Phone: ( )
Fax
N®h~~
Zip,
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
r
Please complete the en~e Application! If the question doesnot apply fill in NA for non
applicable
NAME y'CL ~ t~~' r'~ ~ i~l
PROPERTY ADDRESS , ~ ~ c~ (~~rc'~~ Permit#
SUBDIVISION '~'~ ~ Q ~~`
Required!!!
MECHANICAL
Mechanical Contractor's Name: JV Business Name:
Address City State
Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
Mechanical Estimate $~ (Commercial/Multi Family Only)
FIXTURES & APPLL9NCES 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 /~Q/v
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~,~-
Signature of Licensed Contractor
Date
License number
The City ofRexburQ's permit fee schedule is the same as recruired by the State ofldaho
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^ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ \ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ^ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete: '~"~--~`~~ ~_
Masonry: ~~
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings: /v
Plumbing:
Heating: ~~/
Electrical: ~ ~'''`~"
Roof Trusses:
Floor/Ceiling Joists:_
Siding/Exterior Trim:_
Other:
` ~% ~ .. _ d, i`,.
~ r t ~.
,,.
<: _-,.
Special Construction
(Manufacturer or Supplier)
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