HomeMy WebLinkAboutBP & APPLICATION - 06-00389 - 524 S Golden Willow Dr - ShopZ
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ID
C
CITY OF KERB UKG
PERMIT # •
BUILDING PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the qw ~' - -` ~"'- ~T' ~-_ --- -----L__L,,.
208-359-3020 X326
PARCEL NUMBER: ( 06 00389
524 Golden Willow- Garage/Shop
SUBDNISION: ~~ 1 ~,,,a,..,, ~,c,~~,9,~ U
(Addressing is based on the information -must be accurate)
CONTACT PHONE #~- Z S"33
PROPERTY ADDRESS: _~"Z ~ S, L o 1 ~ (~.~ t 1 r ~.,.7 LL'it/~t
PHONE #: Home ( ) Work ( ) Cell (~) 3s7- 28'33
OWNER MAILING ADDRESS: ~~~ F, 3av ~ ,~tl. CITY:_~i.r~STATE: ZIP: ~3 ye
EMAIL~Y,,.,~5 ~7l ~ ~ P re, ~,r+.~. FAX 2c~fs - ~, S~ -- 01 ~ ~
APPLICANT (If other than owner) ~Ld~~
(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
Work
Cell
__
CONTRACTOR: c~U,t,nJ~°~
MAILING ADDRESS: CITY STATE ZIP
PHONE #: Home ( ) Work ( ) Cell ( )
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE /~ ~ - ~~~
How many buildings axe located on this property?
Did you recently purchase this property? ~ Yes (If yes give owner's name)
Is this a lot split? ~~ lease bring copy of new legal description of property)
PROPOSED USE: k eY~
(i.e., Single Family Resident , ~ y, Apartments, 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 sweaz 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 approval was
sed. Permit void if not started within 180 days. Permit void if work stops for 180 days.
/~/~
tgnature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email or phone? Circk C+ne
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the dme of application beginning, anuarv Z 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*'k
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Please com lete the entire A lication! •
p pp
If the question does not apply 5ll in NA for aon app~cabk
NAME ~,~}t/i!J ~~~R~ l,~S
PROPERTY ADDRESS Z~Y' S. ~ d/~,C~,. x,0.7 ~ ~ , r ~. Permit#
SUBDIVISION ~L(~r9,_, f3n.l,,~c
Dwelling Units: Parcel Acres:
SETBACKS ,tti"'/'7L. f,~ ~
FRONT _ SIDE J ~/. r SIDE BACK
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 ~YJC3~ ~ay Sy, .Fl. Carport/Deck (30" above
Water Meter Quantity: **************Water Meter Size:
(Commercial Only)
Required.!!
PLUMBING
Plumbing Contractor's Name: Business Name:
Address City State Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
FIXTURE COUNT (including roughed fixturesl
Clothes Washing Machine Sprinklers
Dishwasher Tub/Showers
Floor Drain Toilet/Urinal
Garbage Disposal Water Heater
Hot Tub/Spa Water Softener
Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate
Signature of Licensed Contractor
The City o~ j
License Number& Expiration Date Date
's permit fee schedule is the came as required by the State of Idaho
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