HomeMy WebLinkAboutAPPLICATION - 07-00212 - Rudd & Co - Window RemodelCITY OF MXB URG
BUILDING PERMIT APPLICATION Please cc
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
PARCEL NUMBER: , VA�'MD�G` 7 �� J � L (We i
SUBDIVISION: UNIT4
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0700212
Rudd & Co -New Window
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OWNER NAME: lZ A A6 : rQ1U CONTACT PHONE # 3S - .K 6 -7 7
PROPERTY ADDRESS: 1Z I E 104jaJ , i ne7cd.2c-7
PHONE #: Home ( ) Work (za) 3S G - 3c. - 7 7 Cell( )
OWNER MAILING ADDRESS: (5A0A. ) CITY: STATE: ZIP:
EMAIL FAX zo3. 5S-e. • 36.,3
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: ADD
STATE; ZIP
PHONE #: Home ( ) Work (
CITY:
EMAIL FAX
S
CONTRACTOR
MAILING ADDRESS:
PHONE: Cell#
Cell (
Fax#
EMAIL IDAHO REGISTRATION # & EXP. DA
How many buildings are located on this property?
STATE ZIP
Did you recently purchase this property? G) Yes (If yes give owner's name) lu U MAY 1 1 2007 L
Is this a lot split? NO YES (Please bring copy of new legal description of prop rty) L 1
PROPOSED USE: AIE CITY OF R EXB U R G
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt ofperjur 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 proval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner /App ant DATE
Do you prefer to be contacted 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 7anuary 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**
Work#
CITY
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Building Safety Department
City of Rexburg
19 E. Main janellh@rexburg.org Phone: 208.359.3020 ext 326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
4 REXB
C I T Y TT ��
U' O RE� V 1 �G
Americas Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
I,
Name
Address
City State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
A. That I am the record owner of the property described on the attached, and I grant my
permission to:
Name Address
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulting from any dispute as to the statements contained herin or as to the
ownership of the property which is the subject of the application.
Dated this
day of
Signature
Subscribed and sworn to before me the day and year first above written.
20
Notary Public of Idaho
Residing at:
My commission expires:
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Please complete the efire Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT
SIDE SIDE BACK
Remodeling Your Building /Home (need Estimate) $ &000
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:
Requiredffl
PLUMBING
Plumbing Contractor's Name:
s Name:
Address City State Zip
Contact Phone: ( ) Business Phone:
Email_ 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)
Plumbing Estimate $.
(Commercial Only)
Required! Signature of Licensed Contractor
The City of Ike
License number Date
schedule is the same as required by the State of Idabo
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