HomeMy WebLinkAboutAPPLICATIONS, BP - 05-00397 - 284 Mark Ave - New SFRZ
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- CIT?~ OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PERMIT #
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: ~-~'ery[~efL.~oN UNIT# BLOCK# G~ LOT# q'
(Addressing is based on the information -must be accurate)
OWNER NAME: ~,-`a- y~v~cc~-vr~,c,,,J~- G, „~,Q CONTACT PHONE ~
PROPERTY ADDRESS: ~ off- '' <S.
PHONE #: Home (~~ 53a.- U~-S Work (~~) -~3l 'I~~- Cell e ~~~.(~aS~~
OWNER MAILING ADDRESS: (OSf ~- N . Meri~iu,~ CITY: ATE: yD ZIP?'
EMAIL rc~-~ow1~~g ~~_FAX ap X ,3'~, ~6 ~ 3 ca ~ l ~ N ad vaN~c\ ~~
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 ( )
EMAIL
Work ( ) Cell
CONTRACTOR: 1~Z.-'E1 ~~~~Nb~
MAILING ADDRESS: ld$~- ~. !e/~~r~~;o„nI CITY `~,~,pt,~.~ STATE~ZIP~
PHONE: Home# 53a-uu~-5 Work# yv .D Cell# aa~ -~s3~a
EMAIL ~'u~;x.c,k.1,Y~~o~.i~ FAX 53a-tIG~-3 ~l~ i'~- ,dr~veuvcA•,
How many buildings are located on this property? ~ Q ~Q,
Did you recently purchase this property? No es If yes give owner's name) Z-~- ~NVC~si,ML l,~
Is this a lot split? ~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ~ ~ ~ ~ '
(i.e., Single Family Residence, M lti Family,
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 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 180 days.
09 /~/ o.S
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 due at time of application** **Building Permits are void if you check does not clear**
CITY:
FAX
.. .
~~lease cori~ple~e theme ~S~I~l~~t~~.. - . ,~"....,
If the question does not apply fill in NA for non applicable
NAME ~= ~ ; ~N ~-Sr wt,~ ~y ~
PROPERTY ADDRESS Permit#
SUBDIVISION ~e~o ~
Dwelling Units: l Parcel Acres: IN
SETBACKS
FRONT 30~ SIDE `~~ SIDE 'o1r'1,\ BACK 3~~ ; 35~
Remodeling Your Building/Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area ~ ~~ ~
Second floor/loft areal ~ `~ S
Third floor/loft area
Shed or Barn
Unfinished Basement area ~a,t~ g
Finished basement area
Garage area~r'~ ~
Carport/Deck (30" above grade)Area
Water Meter Quantity:
************** Water Meter Size: ~~~
Required!!!
PLUMBING
Plumbing Contractor's Name: ~~~- ~ L..~af~ Business Name: ~,'~ t j ~~a~1.J14:~ ~~' >l 1~1~F
Address ~.®. ~,~C a7 City -~~t~E.~ Stated Zip~p
Contact Phone: (~ ~-- -~F-1 t 1 Business Phone: (~ ~-~-~ t
Email
FIXTURE COUNT (including roughed fixtures)
_j Clothes Washing Machine
~ Dishwasher
~ Floor Drain
Garbage Disposal ?
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
Water Heater
Water Softener
(Commercial Only)
Fax (~,~ ~v- ~(~-` ~~
l .~ Sprinklers I
3 Tub/Showers
y ~ Toilet/LJrinal
~~' -14~ r ~ ~, ~
Signature of Licen d Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
.,
. , _ .....~_,...~., ..__ ~ _ .~...,...., . _,.. _.., .~ .......~ ...~ ... ,...., _,~r .... ,...,:...._.~~ ... .,,
.r . ..
PIeaSe Complete the eri~l ApprlCatlOnl If the question does not apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
MECHANICAL
Mechanical Contractor's Name:: ~ Business Name: 'hN.tT~.t7`~l~l~u.~r
Address ~ ~ q;~ City I~~~ State ' - t-10 Zip
Contact Phone: (tea - 4~c i Business Phone: (29~ ~- .d-~ ~ ~
Email
Fax L2O~~ ~- ~
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES 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
~_ Dryer Vents S
Range Hood Vents
Cook Stove Vents
Bath Fan Vents (~
other similar vents & ducts:
D
t
gs
/3
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
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~ ~ ~~~
Si nature of Licens d Contractor License number ate
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho