HomeMy WebLinkAboutAPPLICATION - 06-00611 - Donegal Bay Apartments - PlumbingAMM16 * r
CH Y OF REXB URG PF R l\ i T`r ++
BUILDING PERMIT APPLICATION Pleas
19 E MAIN, REXBURG, ID. 83440 If the qi 0600611
208 359 - 3020 X326 //�� ' y Donegal Bay -Water Htr Replacement
PARCEL NUMBER: 1� W) f" w � (Q ( 1) 40 1
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
I
e
NTACT PHONE #
PROPERTY ADD
PHONE #: Home ( ) 5 r!,- O S Work ( ) v Cell ( )
OWNER MAILING ADDRESS: A 0. W1 f CITY: STATE: _Zrw>ZIP: C_ 3YXa
APPLICANT (If other than owner) '
(Applicant if other than owner, a statement aukhorizmg Jpphcant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 35 00 15� CITY:
STATE; 1 �1. . ZIP EMAIL FAX
PHONE #: Home ( ) .5�, �7G � Work ( ) Cell ( ) _3 9/1— 5155
CONTRACTOR
MAILING ADDRESS: 7 7 71 56_n6 L= CITY STATE T' ZIP Z3_
PHONE #: Home ( ) - Work ( ) Cell ( ) 3:ZQ 40 7 2
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property?
Did you recently purchase this property2:1iji) 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 perjur I hereb certif
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 if not starteg(withiyl 1$0 days. Permit void if work stops for 180 days.
of 91 er /Ap
DATE
you prigr to be conlac{ed 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 anua& 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 eitire A lication! 0
p pP
NAME ( e-a & 4ee-
PROPERTY ADDRESS ! 7 71 3 5c� r Permit#
SUBDIVISION
Dwelling Units: b a 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 are:
Second floor /loft area Finished basement area_
Third floor /loft area Garage area
Shed or Barn Carport /Deck (30" above
Water Meter Quantity:
Requlredffl
PLUMBING
Plumbing Contractor's Name: Business Name:
Address City State Zip,
Contact Phone: ( ) Business Phone: ( )
Fax
FIXTURE COUNT (including roughed fixtures
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)
* * * * * * * * * * * ** *Water Meter Size:
Plumbing Estimate $ 3 �(OOMMERCIAL /MULTI - FAMILY ONLY)
icense Number& Expiration Date
Signature of Licensed Contractor
The
Date
schedule is the same as required by the State of Idaho
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