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HomeMy WebLinkAboutAPPLICATIONS - 08-00273 - CottonTree Inn - Plumbingy.X6U Qu a N CITY iJ t v RE B V1\ CW Please Comp the Entire Application! If the question does not apply fill in N 1 for non applicable America`s Family Community tHFQ COMMERCIAL & MULTI FAMILY BUILDING PERMIT A 19 E MAIN, REXBURG, ID 83440 0800273 208 - 359 -3020 X326 450 W 4th S - Cottontree Inn Water Heater PARCEL NUMBER: (We will pr SUBDIVISION: UNIT# BLOCK# LOT# is based on the information - must be OWNER NAME. • CONTACT PHONE # PROPERTY ADDRESS: PHONE #: Home ( ) Work ( ) Cell ( ) OWNER MAILING ADDRESS CITY: �A'/:Jyr9 STATE r ZIP:_s 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: ADDRESS CITY: STATE; ZIP EMAIL FAX PHONE #: Home ( ) Work ( ) Cell ( ) CONTRACTOR MAILING ADDRESS: 3 / �! ",ft cITY STATE tZ ZIP PHONE: Cell# Work# Fax# EMAIL IDAHO REGISTRATION # & EXP. DATE / 5 :G I — � How many buildings are located on this property? Did you recently purchase this property? No Yes (If yes, list previous 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.) — CIRCLE ONE 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 thS,15fiDmit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. Signat�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 lanuAv 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** K 9 44 Building Safety Department City of Rexburg 19 E Main ionellh @rexburg.org ID 83440 www.rexburg.org Phone: 208.359.3020 x326 Fax: 208.359.3024 OI 'ex Htra U Q T. CITY OF REX cy, Americas Family Communiiy 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: Required!!! PLUMBING Plumbing Contractor's Name: �� Business Name: Address 9Y3 Al City t State ZX Zip sP—�© Contact Phone: ( ) Business Phone: Email Fax FIXTURE COUNT (includingroWhed fixtures) Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub /Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ �G�/_�� (Commercial Only) Sprinklers Tub /Showers Toilet /Urinal Water Heater Water Softener Required! Signature of Licensed Contractor License number The City of Rexburg's permit fee schedule is the same as reguin el /c Date the State 4