HomeMy WebLinkAboutAPPLICATION - 06-00396 - 328 W 2nd S - Lawn Sprinklers• ,CITY OF AEXBUKG ~ ,.r",,, "^" ~`
BUILDING PERMIT APPLICATION Please c~ 06 00396
19 E MAIN, REXBURG, ID. 83440 If the questi,
208-359-3020 X326 `-~ C ~ !, 328 W 2nd S -Sprinkler
PARCEL NUMEER: ~1' ~'`-w~` ~` ~~V (Wc
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE
PROPERTY ADDRESS: v~ ~ C,t~ • ~ .c~c/~
PHONE #: Home ~/y) c~~SG' l~ ~ Z Work ( ) Cell ( )
OWNER MAILING ADDRESS: //~%~ /`~u~C~~Tk.Ss~1:~~ (:iT'Y: /~z~~ ~a~r~STAT~ZIP;1~~~1 O
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 CITY:
STATE; ZIP.
PHONE #: Home
EMAIL F
Work ( ) Cell
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE #: Home ( ) Work ( ) Cell
EMAIL FAX 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)
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, 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 approval was
based. Permit void i£. t started within 180( days Permit void if work stops for 180 days.
Signa of Owner/Applicant DATE
Do you prefer to be contacted by f email r phone? Circle C-ne
WARNING - BUI PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning,Tanuar~. 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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'lease corn lete the •ire A lication!
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If the question does not apply fill in NA for non applicable
NAME ~._~,R-~ ~~ y ~- ~M~(S~~/.
PROPERTY ADDRESS ~ ~- ~' C-c.) ~ ~~,~~ ; Permit#
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT SIDE 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 Carport/Deck (30" above grade)Area
Water Meter Quantity:
**************Water Meter Size:
Required.!!
PLUMBING
Plumbing Contractor's Name: G~'~iU~/~ Business Name:
Address ~~ ~ ~ • ~'y ~ ~ , City ~ - ~ State Zip C~1.3%
Contact Phone: (6~rj) ~' J~C~~' ~' ~~.`f" Business Phone: ( )
Email~~ Y ~~.~ ~~~(~ /~ Li00 , ~~~ Fax
FIXTURE COUNT (including roughed fiartures~ /
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 $ (Commercial Only)
Signature of Licensed Contractor License Nuxnbex& Expiration Date Date
The City of Kexburg's permit fee schedule is the .came as reguired by the State of Idaho
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