HomeMy WebLinkAboutAPPLICATIONS - 06-00338 - 253 E 2nd S - Lawn SprinklersCITY OF REXB URG
BUILDING PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the que~ -
208-359-3020 X326
PARCEL NUMBER: ~~i ~,~~(.~{~~~ (, 0 6 0 0 3 3 8
SUBDIVISION: ~ 253E 2nd S-Sprinkler
(Addressing is based on the information -must be accurate)
OWNER NAME: Boyd W/ect~~ter-S~ n CONTACT PHONE # 356- ~~00
PROPERTY ADDRESS: ~ $3 C • ~+ "=~ ~.
PHONE #: Home (Zo8) 3 S6- 75/0.0 Work (~08) 356' 9~ ga- Cell ( )
OWNER MAILING ADDRESS: as_3 ~• ~ "~ ,~. CITY: /~~,~~STATE:l~ZIP: ~',~yyo
EMAIL FAX
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
STA
ZIP EMAIL
PHONE #: Home
Work ( )
PERMIT #
CONTRACTOR:
MAILING ADDRESS:
PHONE #: Home ( )
EMAIL FAX.
CITY
CITY:
_FAX
Cell ( )
STATE ZIP
Work ( ) Cell ( )
IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property? /
Did you recently purchase this property? No Yes (If yes give owner's name) /~/p
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commerci ',~n~-~ts.
~ ~ a
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZAT ~enattya ertify
that I have read this application and state that the information herein is correct and I swear that an ation which may hereafter b v by me
in hearings before the Planning and Zoning Commission or the City Council for the City of Rexbu s be trµ~~l ~d~or~I a mply
with all City regulations and State laws relating to the subject matter of this application and hereb t ized }e sentative e C e ter
upon the above-mentioned property for inspections purposes. NOTE: The building official may r voke permit on approval issued u der th
provisions of the 2003 International Code in cases of any false statement or misrepresentation of f ct in nnwh h the
permit or approval was based. Permit void if not started within 180 days. Permit void if work sto s f~ ~ y~ F R FX ~ ~ R !'f
~l~lQ,o
Signatu4fe of Owner/Applicant DATE
Do you prefer to be contacted by fax, email o phone Circle One
WARNING -BUILDING PE UST 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 ~p ya ~Q.O~~ ~er S ~ o r
PROPERTY ADDRESS ~,Z, $3 ~' ~ ~~ ~' . Permit#
SUBDIVISION
Dwelling Units:
SETBACKS
FRONT
SIDE
BACK
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 grade)Area
Water Meter Quantity:
************** Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name:
Address
Contact Phone: ( )
Email
City
Business Phone:
Fax
State Zip
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)
Water Heater
Water Softener
Signature of Licensed Contractor License number Date
The Cary of Rexburg's permit fee schedule is the same as required by the State of Idaho
Parcel Acres:
SIDE
Business Name:
Sprinklers
Tub/Showers
Toilet/Urinal
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