HomeMy WebLinkAboutAPPLICATION - 05-00445 - 140 N 4th W - GarageCITY OF REXBURG ~'~'~'~ `~T "'
` BUILDING PERMIT APPLICA~N Please c
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
(~
~~
OS 0044_5
140 N 4th W-Garage Addition
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: ~~~~N ~~ /~-~
PHONE #: Home (~ ) ~~C G>~'C /Work
OWNER MAILING ADDRESS:
EMAIL
FAX
Cell ( )
CITY: Q G~~" STATE~ZIP:~~ll~
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 ( ) ~~-~!7'''~ Work
Cell ( ) ~j~3~~C / ~/
CONTRACTOR:
MAILING ADDRESS: ~ G~~ ~ ~? ~~ I'~~ CITY /~.~ ~ ~ 6l TATE~~.
PHONE: Home# ~~l /1~~,~Work# Cell# ~~~ ~ i
EMAIL
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
PROPOSED USE: 1~ P ~
(i.e., Single Family Residence, Multi
(Please bring copy of new legal description of
,Apartments, Remodel, G~ 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 was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email or phone Circle One
WARNING -BUILDING PE 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**
FAX
If the ques
If the ue 'on does not apply fill in NA for non applicable
NAME i ~G~~
PROPERT ADD S Permit#
.,..
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT SIDE 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
Unfinished Basement area
Finished basement area
Garage area~7`~
Carport/Deck (30" above grade)Area
Water Meter Quantity:
************** Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name:
Address
Contact Phone: ( )
Email
BACK
Business Name:
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)
.~
City
State Zip
Sprinklers
Tub/Showers
Toilet/LTrinal
Water Heater
Water Softener
Signature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State ofldaho