HomeMy WebLinkAboutAPPLICATION - 08-00271 - 233 E 2nd S - Lawn SprinklerR Exac k
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Americas Family Community
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Please Complete the Entire Application!
If the question does not apply fill in NA for non applicable
RESIDENTIAL BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID 83440
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)
Dwelling Units: Parcel Acres:
OWNER NAME �, e 11u^- /C - //k f 4 CONTACT PHONE #
PROPERTY ADDRESS: X02., E • 2 ^` S
PHONE #: Home ( ) Work( ) — Cell (
OWNER MAILING ADDRESS: CITY: — STATE: 177 ZIP: 93W G'
EMAIL _ ____...__ FAX
APPLICANT (If other than owner) U �U, +i:)�, k L e , ,,�d sc e, P ,I C
(Applicant if other than owner, a statement authorizing applicant to act as agent fox owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS /Z crX CITY:
STATE; SS) ZIP :7:3 YV0 EMAIL FAX Z G 6 S E G (//
PHONE #: Home ( ) Work ( leg 6 1� ° - S'ZZ O� Cell( ) —
CONTRACTOR
MAILING ADDRESS:
PHONE #: Home ( ) Work
CITY STATE ZIP
Cell (
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE /2c _ /// 3 0
How many buildings are located on this property,' r
Did you recently purchase this property' No _,,Yes (If yes, list previous owner's name)
Is this a lot split ? YES (Please bring copy of new legal description of property)
(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 buildi g official may revoke a permit on approval issued under the provisions of the 2003 International Code in
cases of any false statement or misrepresent . or]�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 yC Kfops for 180 days.
Signature of O /App c �~ DATE'
ARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning fanuM L 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**
Building Safety Department y tiRt,k, a
City of Rexburg 7%
19 E. Main jonellh @rexburg.org Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fox. 208.359.3024
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C I T Y OF
REXB V RG
America's Family Community
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:
RequiredLY
PLUMBING
Plumbing Contractor's Name: Business Name:
Address City State Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
FIXTURE COUNT (includingroughed fixtures
Clothes Washing Machine iv Sprinklers
Dishwasher
Tub /Showers
Floor Drain
Toilet /Urinal
Garbage Disposal
Water Heater
Hot Tub /Spa
Water Softener
Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate $ y
y ,
(COMMERCIAL /MULTI - FAMILY ONLY)
Licensed Contractor
The
VIE i� o
License Number& Expiration Date Date
schedule is the same as required by the State of Idaho