HomeMy WebLinkAboutAPPLICATION - 08-00263 - 331 Eagle Summit St - Lawn SprinklerPlease complete the entir A p p lication!
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NAME �Q� � 1 1' LA
PROPERTY ADD S 3 - 6( E 0. g I e
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT
If the question does not apply fill in NA for non applicable
0800263
331 Eagle Summit St
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 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:
Requiredl!!
PL UMBING �Q � u�
Plumbing Contractor's Na�mee: �+ Business Name:
Address �!D r " ity State Zip 9 3 1
Contact Phone: ( ) r 7 Business Phone: ( )
Email Fax - 0 7 5 7 3 12—
FIXTURE COUNT (including roughed 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 s permit fee schedule is the .came as required by the State of Idaho
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CITY OF REXB 0
PERMIT #
BUILDING PERMIT APPLICATION Pl ease complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208 -359 -3020 X326
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER NAME: CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING _ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
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: ADDRES
STATE; ZIP
PHONE #: Home (
EMAIL F.
Work ( ) Cell (
CITY:
CONTRACTOR
MAILING ADDRESS: k`}'�9 to tJ l 15 C CITY.
TE ZIP Z53 (40
PHONE #: Home ( ) Work ( ) Cell ( ) Q-? t '7 3 t q
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE erry3q Z /oq
How many buildings are located on this property?.
Did you recently purchase this propertyr 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 penalty of perjury, I hereby certify
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 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 fanuary 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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