HomeMy WebLinkAboutAPPLICATION - 08-00364 - Homestead Assisted Living Center-SprinklerSEX B l,'g
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Americas Family 00 OO )
Center
COMMERCIAL & MULTI FAMILY BUILDING PERK. HOnleStead ASS1Sted LivIng
19 E MAIN, REXBURG, ID 83440 rinkler
208 - 359 -3020 X326 Lawn S p
PARCEL NUMBER: (We w ... t ,,uvicle this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
is based on
- must tle accurate
OWNER NAME.- &S5, , -,*CONTACT PHONE #
PROPERTY ADDRESS: �b� �• �
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT (If other than owner) 5tfet s or. � W L r :tom c.,.
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS P. 66- CITY: �� /,,
STATE; T ZIP O ? O 5- EMAIL yZ51 A) KU,,o.e,,o a 4-1 -- h
o
PHONE #: Home (a>,_j r`' - -- 33 / '�- Work ( ) Cell (7z, ,J 6F/ — '33 I 8 (P" , f
CONTRACTOR '5 r s
MAILING ADDRESS: CITY STATE ZIP
PHONE: Cell# Work# Fax#
EMAIL IDAHO REGISTRATION # & EXP. DATE
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: Y f Jo, 'fir
(i.e., Single Family Residence, Multi tamily, Apa:
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 W the plans on wlAb tye pemvt or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
of Owner /Applicant
I/ -,?- 9 / OR
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 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**
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Building Safety Department
City of Rexburg
19 E Main
Rexburg, ID 83440
joneiih @rexburg.org
www.rexburg.orq
Phone: 208.359.3020 x326
Fox: 208.359.3024
0� R'p,XBURC
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CITY OF
1 EXB V 1\V
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: West .Business Name:
Address 'P 0. 1, c >c C 1 City Ufa l„o{& I Is State -TD Zip 8 3 q 6-T
Contact Phone: (-i. e) 5 2- - 3 i Business Phone: ( )
Email Fax 5 25 - 33-46
FIXTURE COUNT (including roughed fixtures
Clothes Washing Machine Sprinklers
Dishwasher
Tub /Showers
Floor Drain
Toilet /Urinal
Garbage Disposal
Water Heater
Hot Tub /Spa
Water Softener
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
of Licensed Contractor
The Citv of1�i
(Commercial Only)
License number
s permit fee schedule is the same as
Date
the State of Idaho
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