HomeMy WebLinkAboutAPPLICATION - 06-00214 - Agenda Clothing - RemodelCITY OF KEXB UKG
BUILDING PERMIT APPLICATION Pll 06 00214 ton!
19 E MAIN, REXBURG, ID. 83440 If tl 40 W 1st S-Agenda Clothing icable
208-359-3020 X326 ~~ rr~~~""
PARCEL NUMBER: ~~~Xg 1o~~`I~i(!~,~_\ we will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
Is based on the information -must be
OWNER NAME.• CONTACT PHONE # "\~y ~ 1 l0'1 ~ lo5'~i
PROPERTY ADDRESS: ~O ~'~~~~° -~_ ~;~
PHONE #: Home ( ) Work ( ) Cell (1~~ 1(~1' (~~j31
OWNER MAILING ADDRESS: ~o l~s ~, X51= •,~.1~., CITY: STATE~~ZIP:~i-~y~p
EMAIL C -,~~.n~ ®XI ~'•~,ta° ' ~~.
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 FAX
Work ( ) Cell
CONTRACTOR:
MAILING ADD
PHONE: Home#
s~
Work#
-CITY STATE ~~ ZII'
Cell# ~l\11~11~^l-[.5~~ Fax#
EMAIL IDAHO REGISTRATION # & EXPIRATION DATE
How many buildings are located on this property?
Did you recently purchase this property?~ Yes (If yes give owner's name
Is this a lot split?(N~O
PROPOSED USE``:
(i.e., Single Family Residence,
YES (Please bring copy of new legal description of property)
\ P1 n~_11J
Family, Apartments,~inodel, 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 inforn~ation 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 2003 International Code in cases of any false statement or misrepresentation of fact
in the application or o~ s o which the=mut or approval was based. Pernut void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Clwner/Applicant ~ ~ qp 2
Do you prefer to be contacted by fax, email or phone? Circle One y (~
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTR N SITE!
Plan fees are non-refundable and are paid in full at the time of application begi u 1 2005. q
City of Rexburg's Acceptance of the plan review fee does not constitute n prov~~Y 2 2~
'k*Building Permit Fees are due at time of application** 'k*Building Permits are void i your eck does not clear'K*
CITY:
CITY OF REXBURG
•
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT SIDE SIDE BACK
~,. O ~ -ooh
Remodeling Your Building/Home (need Estimate) $_
SURFACE SQUARE FOOTAGE.• (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement area
Second floor/loft area Finished basement area_
Third floor/loft area Garage area
Shed or Barn Carport/Deck (30" above
Water Meter Quantity:
"~''` Water Meter Size:
Required.!!
PLUMBING
Plumbing Contractor's Name: Business Name:
Address Ciry State Zip
Contact Phone: ( ) Business Phone: ( )
'Email F
FIXTURE COUNT (includin,~ roughed fiartures)
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
Required! Signature of Licensed Contractor
The City of Bc
Water Softener
License number Date
s permit fee schedule is the same as required by the State of Idaho
4
. ~ ~ EXEMPTIONS FROM STATE REGISTRATION
,•
As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your State
registration number or your exemption from the State registration. Please send a copy of your state registration or
fill out this form showing your exemption and send it with your license renewal or your next permit application.
(This list is a summarization of Idaho Code Title 54 Chapter 5205, for full definitions of these exemptions please
see the State's website at ~~e~w~iht>l.ic~~ihc>.~~%c~~nthtm)
^ Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
3 Architects,
10 Electrical Contractors/Journeyman,
12 Engineers/Surveyors,
19 Public Works Contractors (exempt from fee only registration required),
26 Plumbing/Plumbers,
45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or
50 Installation of heating, ventilation and air conditioning systems
^ Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable
activity with no wages or salary
^ Employee of a US Government agency (State, City, County, or other municipality)
^ Public Utility doing construction, maintenance, or development to its own business
^ Involved with gas, oil or mineral operations
^ Supplier doing no installation or fabricating
^ Contracting a project or projects with a total cost less than $2000
^ Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code
^ Any type of water district operations
^ Work in rural districts for fire prevention purposes
^ Owner who performs work on own property or contracts with a registered contractor to do work as long as
the property is not for resale within 12 months
Owner or lessee of commercial property performing maintenance, repair, alteration or construction on that
property
^ Real estate licensee/property manager acting within Idaho Code
^ Engaging in the logging industry
^ Renter working on the property where they live with the property owners approval
^ Construction of a building used for industrial chemical processing per Idaho Code
^ Construction of a modular building (defined by Idaho Code) to be moved out of state
I hereby certi e above information is true and correct to the best of my knowledge.
i~" /
S}~a e n Date .
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