HomeMy WebLinkAboutAPPLICATION - 06-00236 - 45 S 3rd E - Remodelj., s
CITY OF REXB URG , DL'DAifT'I' -Ed •
BUILDING PERMIT APPLICATION Please ~
19 E MAIN, REXBURG, ID. 83440 If the q~ 06 00236 e
208-359-3020 X326 45 S 3rd E-Window Replacement
PARCEL NUMBER: ~1~~~~~a J~~
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
-OWNER NAME: CONTACT PHONE #
PROPERTY ADDRESS: ~~j S ~r~ ~
PHONE #: Home (?~) 3C~~ -~~~~ Work ( ) Cell ( )
OWNER MAILING ADDRESS: Sanv~.F CITY: STATE:~ZIP:~~
EMAIL FAX
APPLICANT (If other than owner) ~,,,w~..
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; .
PHONE #: I~olr~e
ZIP EMAIL
FAX
Work
CITY
Cell
STATE ZIP
MAILING ADDRESS:
PHONE #: Home
Work
EMAIL FAX
Cell
IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property? 1
Did you recently purchase this property?~ Yes (If yes give owner's name)
Is this a lot split. NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, ~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 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 on the plans on which the
permit or a~val was based. Permit vclid if not started within 180 days. Permit void if work stops for 180 days.
Signature o caner/Applicant DATE
Do you p efer 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 your check does not clear**
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Please complete the entire Application.
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units:
SETBACKS
FRONT
Parcel Acres:
SIDE SIDE
Permit#
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
Carport/Deck (30" above g
Water Meter Quantity:
************** Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name:
Address
BACK
City
Business Phone:
Fax
Contact Phone: ( )
Email
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)
Sprinklers
Tub/Showers
Toilet/LJrinal
Water Heater
Water Softener
Signature of Licensed Contractor License number Date
The Cdty of Rexburg's permit fee schedule is the same as required by the State of Idaho
Business Name:
State
Zip
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 www.ibol.idaho.gov/cont.htm)
^ 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 certify that the above information is true and correct to the best of my knowledge.
nature Date
Print Name
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