HomeMy WebLinkAboutAPPLICATIONS - 07-00016 - 351 S 3rd E - PlumbingJAN -18 -2007 THU 09:57 AM FIR CALL JEWEL
C1TY0FRMUR(W
BUILDING PERMI APPLICATION Plea
19 E MAIN, M- NBURG, ID. 53440 If the
208 359 3020
FAX N0. 12085292793
V 000 16
351 S 3rd E
P. 02
x22 Wtr Htr Replacement
PARCEL NUMBER.
SUBDIVISION: 441�L LUNM' -- . .H1Uvtuc LMS zor you)
B LOCK# LOT#
(Addressing is based on the information - must be accurate)
PROPERTY ADDRESS: _3,5
CONTACT PHONE #
PHONE #: Homc ( ) - Work ( ) Cell ( )
OWNER MAUNG ADDRESS: CITY: STATE- ZIP:, 0, 0
EMAIL FAX
(If other than owner)
(Applicam if other than owner, a smtt;merrt authorLtnC applicant to aoi as agent for owner most accompany this
APPLICANT INFORMATION: ADDRESS
CITY:
STATE; ZIP B MrAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTBACT4� 71 71
MAILING ADDRESS: l b CITY STATE-22LZIP L D/
PHONE: Horne# Work# _�777 Ca11#
EMAIL FAX CJ- 7 1.3
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 (PIease bring copy of new legal description of property)
PROPOSED USE:
(i.e., ShWe Family Residence, Must! Family, Aparrmenta, Remodel, Craragee Commercial, Addition, Etc.)
APPLICAI'TT' S SI(D;ATURE, CERTIFICA 770'N AN,'D AUTHORIZATION: Under p�aalty of pMury, t hereby mow* tbm I
We mad ttu apps =aM and store that the mfnmmdon hereto is ooaoat card I swop tfwt arty iafanmapon which may h=x tr 6e given by me {a heerinp� betas rba
p18nNog sad ZpAfrlg Coau4ftaion or the City CotmoiJ ,far the City of Rexburg �� be au�ttW a„d coaect I agree to comply with all City regulations and Sane laws
feladaa to the sabjott triWer of thfo upplication and hemby euthatind represattaow of the Clty to east ttpon the above- poloncd property for mspectioas purposes,
NOTE: The bufldia$ afRcial taay revoke a permit on approval Word trader the: provftians of the 2000 Iat madoaal Codc in cases of my false shit or
m
arePWe2tation of facr.in tha applle adon or on the plMs on whfoh du pctthft or approval was boot& Permit vo)d ifrot started wit in 290 days. knit void ifwork
stops for Igo days,
Si�oatttre of0WIM /AppHe4Z DATP
Do you prefer to be concocted by fax, email or phone? Circle One
WARMG- 13MMING PERMIT 11f "IM POSTIM ON CONS l
Plan :sae wo 4031- rdandable and are paid In faU at the OM of APPAW4oet
Cary ofRmburg's Accept m of the plea rwim fW dW not eon ppr
JAN 10 2007
CITY OF REXBURG
JAN -18 -2007 THU 09:57 AM FIR CALL JEWEL FAX N0, 12085292793 P. 03
Jan. 17, 2001 10:41AM No, 3514 P.
2
malt Polak dal tlmo of syRU~• •
` Pleafe cOMplete the entire Appl�icationt du�.�.�doa.ora ►•
NAME If the question does not apply fl11 in NA for Wn applicable
PROPERTY ADDRESS Permit#
SUBDIVISION
Dwelhg Ututs: Pared Ac na:
SETBACKS
FRONT SIDE SIDE
B,ACIC
'Rano"M Your BNRAWS "I (need F.at�) S
SURP.IC,B SQU,9RE FWTAGR: (Shall inoluda the exteriot wall meestaements of tire building)
Finer Floor Area
Second floodloi} area
Third floor /loft area
Shad or Barn
Udniahod Basement am
Finished basement area
(age area
CO /Deck Or above Qra&Ut m
Water Meta Comt:
Ways Meter Nor
Required! !1 T
PLUMBING
Plumbing Ccmtrector's Name:
Business Name:
Addrm City
Comtact �vk.'
one. ( �
BusimssPho , ( ) ' 2. - 7 7 7
E mail 1 M •
Fax
Clothes Washing Machine
Dishwasher
- Floor Drain
�. Garbage. Disposal
Hot Tub/Spa
OAvatnri ®s, kitchens, bat, mop)
Spdnklcrs
Tubi✓Showm
Tollet/tlrinAl
Water Neater
Water sob=
PbMWE Vats S (Co)
eiaromtucs of Licowod Coo�ctar l� D
- D
L ease owanboot p�
:....,, T ,, Y �fR 's prr rlee sdisdub !a tJ6a ,tenum as rawked byAv State ofldaho