HomeMy WebLinkAboutAPPLICATIONS, BP - 06-00158 - 228 N 3rd W - ShedZ
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CITY OF REXB URG • PERMIT #
BUILDING PERMIT APPLICATION
19 E M~iIN, REXBURG, ID. 83440
208-359-3020 X326
Please co
If the questic
PARCEL NUMBER:~~~~I (fir ~( We
SUBDIVISION: UNIT#
(Addressing is based on the information -must be accurate)
BLOCK# LOT#
OWNER NAME: ~~ .~ a /~/ /V ~ J ~ n s't' h CONTACT PHONE #
PROPERTY ADDRESS: ~ ~- ~ -'l/„~,- ¢~ % ` ~~~/ Gv~'~"f ~~,~ s"~~~,
~- ~ y s-C,
PHONE #: Home (~) 3 s~ ~ - 3 y s~ % Work ( ) Cell (;; ~'j S ~ l /.3Z
OWNER MAILING ADDRESS: ~% ~ 5I ?~' ~~-/Gzi CITY: /"r~~,.Y~<r~-; STATE:L~ ZIP: ~'-3y~'°
EMAIL ~i "~ ~ `r' ~ S CJ Cdz ~~~~ uh ~ ~ ti e ~ FAX
APPLICANT (If other than owner) /V J~
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
STATE; ZIP EMAIL
PHONE #: Home ( ) Work ( )
CONTRACTOR:
i~fTr',c
PHONE #: Home ( ) Work (~'~Y) ~ c J U Y 3 ~~
How many buildings are located on this property? ,3
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
PROPOSED USE: Sf ~~ .-~
(i.e., Single Family Residence, Multi Far
Apartments, Remodel, Garage, Commercial, Addition,
~,~ i5 ll U ~~ '
MAR ? ~ 2006
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.
~~/~~V/fib
Signature of Owner/App ' ant DATE
Do you prefer to be contacted by fax, email or~on~ 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 your check does not clear**
06 00 ~ 58
228 N 3rd W-Shed
3
Please com lete the en~re A lication.
P PP
- If the question does not apply fill in NA for non applicable
NAME - ~~ ~, f~` ~j/, ~ e ~i,Ie ~
PROPERTY ADDRESS ~ ~ ~ ~j~.~ ¢t~ j ~, ,'r~/~j~Sf f1~z~~~,~-7 ~~ ~~yy,~Permit#
SUBDIVISION
Dwelling Units: l Parcel Acres: ~ ~ ~ ~S~
FRONT KS 1J ~ SIDE ~ / ~' SIDE l ~ ~ BACK ~-~
Remodeling Your Building/Home (need Estimate) $ ~ , 3 ~ ~~ . ~
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
Carport/Deck (30" above g
Water Meter Quantity:
************** Water Meter Size:
Required... ~,~.
PLUMBING t
Plumbing Contractor's Name:
Address
Contact Phone: ( )
Email
City
Business Phone:
Fax
FIXTURE CDUNT (including roughed fixtures)
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
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
Business Name:
State
Zip
4