HomeMy WebLinkAboutAPPLICATION - 08-00262 - 263 S 4th W - Plumbing0
•
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
NAME �t�2Q N 6 C u 1 eve
PROPERTY ADDRESS 0 5 • AAA A - W 0800262
SUBDIVISION 263 S 4th W
Dwelling Units:
SETBACKS
FRONT
Parcel Acres:
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:
Meter Size:
Req uired rll
I'L I ;T.lV1.B'ING (-
Plumbing Contractor's Name: Mn--"fPC ��UutnnV�i&& Business Name:
Address ( `k 3Cf ( d J U S- E City --1-
Contact Phone: ( ) Business Phone: ( )
to Zip $3y01
FIXTURE COUNT & clu din g ro u gh e d fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub /Spa
Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate
(Commercial Only)
Sprinklers
Tub /Showers
Toilet /Urinal
Water Heater
Water Softener
Signature of Licensed Contractor License Number& Expiration Date Date
The City of Kexburg'., permit fee schedule is the same as required by th Sta te of Id aho
4
CITY OF KEXB UG 0
BUILDING PERNIIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208- 359 -3020 X326
PARCEL NUMB
( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
UW1V_P_X NA_MJ_1`. S4 14 N t CONTACT PHONE # 35 ` `mil
PROPERTY ADDRESS: q W
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
E1\IAIL FAX
APPLICANT (If other than owner) messier lt,(,4tt
(.applicant if other than owner, a statement authorizing applicant to act as agent for o er must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY: j d o_l o d'dffs
STATE; Iok ZIP $ 3y0( EMAIL UkOSI " FAQ �US -73g
PHONE #: Home ( ) Work ( ) ' c ) Gg ( 7 3 `T' q
CONTRACTOR
MAILING ADDRESS: CITY
PHONE #: Home (
EINL -IL FAX
PERMIT #
0
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
Work (
Cell (
TE ZIP
IDAHO REGISTRATION # & EXP. DATE e LO'3�1 12 �€
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 penalt 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 started within 180 days. Permit void if work stops for 180 days.
Signature of Owner /Applicant DATE
Do you prefer to be contacted by fas, 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 T„ anuary 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 **
2