HomeMy WebLinkAboutAPPLICATIONS - 08-00328 - 1253 E 9th N - Lawn SprinklerC IT Y OF 16
REXBURG
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America's Family Community
Please Complete F e 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 NUMB
We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER NAME: �r � `jvAk CONTACT PHONE # 3fZ e`1 �L
PROPERTY ADDRESS: Z &1 2- CrXre_ AVe
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: fD ZIP: 93 41
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: ADD
CITY:
STATE; ZIP EMAIL F�
PHONE #: Home ( ) Work ( ) Cell (
CONTRACTOR
MAILING ADDRESS: 12-6 - 5 L f7'14 /V CITY STATE r ZIP 6 a YIyn
PHONE #: Home ( ) Work ( ) Cell ( )
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE
How manv buildings are located on this property? k
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.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt 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 &anuary 1, 2005.
Building Safety Department
City of Rexburg ' O
19 E. Main janellh@rexburg.org Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
CITY O F
REXIiURG
Americas 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:
Required.!!
PLUMBING Val a,t r ice_ 0c o--3
Plumbing Contractor's Name: Skase v ' c.1,1c- Business Nam
Address 253 ( C�TH City r� �''� State [r) Zip f<�
Contact Phone: (Zc ) ,? c_ -Y Business Phone: (2c) a — 7 9�C
Email Fax
FIXTURE COUNT (includin,p, roWhed fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub /Spa
Sinks (Lavatories, kitchens, bar, mop)
k Sprinklers
Tub /Showers
Toilet /Urinal
Water Heater
Water Softener
Plumbing Estimate (COMMERCIAL /MULTI - FAMILY ONLY)
�1 - 9 f 9 Z` �; 7 -9 -06
gnature of Licensed Contractor License Number& Expiratio Date Date
The City of Rexburg s permit fee schedule is the same as required by the State of Idabo