HomeMy WebLinkAboutAPPLICATION - 07-00225 - 20 S 3926 W - New SFR Mechanical•
City Of Rexburgl Madison County
BUILDING PERMIT APPLICATION ' l
19 E MAIN, REXBURG, ID. 83440 f Li
208 - 359 -3020 X322
PARCEL NUMBER: IU .0 \/E 1 LO U ) (
SUBDIVISION: 6 -•- Y y L rw s r1� UNIT#
(Addressing is based on the information - must be accurate)
0700225
20 S 3926 W -Cnty Mech
BLOCK# ,4 LOT# 3 3 F
ORMR : CONTACT PHONE # (2 o S ) 2o/ - /G oo
PROPERTY ADDRESS:
PHONE #: Horne Work ( ) Cell (
OWNER MAILING ADDRESS: f c> :C 4✓a//ee e e- CITY: _STATE: — TA ZIP: $.3 2 2
EMAIL e_ rte. Ca��r. �g,.
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
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS: SU c' w4 //a ee CITY !/I_�� s STATE -�� ZIP X22
PHONE: Home# k* 2. - /Goo Fork# Cell#
EMAIL r,*,, , . e.,.l., e,..* s.. /,c •_hAX SOS 3S�/ ' "� B'l3
How many buildings are locvtt3 on this
Did you recently purchase tliis property? No es If yes give owner's rla nc) L - - --
Is this a lot split? NO YES (Please bring copy of new legal description of pro{icrty)
PROPOSED USE: _ _ 5 " . - / , e -�* r /f ltys�Vv ., e tr
(i.e., Single Family Residence, Nfeti Family, Apartments, Remc&l, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION Under penalty of perjury 1 herchy certify that t
have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by rite 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.
MOTE: The building official may revoke a permit on approval issued under the provisions of the 2000 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 started within 180 days. Permit void if work
stops for 180 days.
Signature of Owner /Applic (f+ME U wy n E loo you prefer to be c to ted by fax, entail or i n Circle One ® l� v
WARNMG — BUILDING PERM1 T MUST BE POSTED ON CO NSTRU ITEI
Plan fees are non - refundable and are paid In full at the time of application begina a d 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan app al AY 1 G Lou] �
CITY:
CITY OF REXBORG