HomeMy WebLinkAboutAPPLICATIONS - 08-00381 - 515 Laurel - Porch Addition�VExevp�
CITY OF
REXBURG
Ow
America's Family Community
AL
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 9
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PARCEL NUMBER: ILP j7 X CA OZ 6 Z ( We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT #_
(Addressing is based on the information - must be accurate)
Dwelling Units: Parcel Acres:
Vt k, I ew CONTACT PHONE # '5 55 9 - 9
PROPERTY ADDRESS: //
PHONE #: Home (loo 5 Z 7 7 2_ Work ( ) . - :3 re-3 1 Cell( )
OWNER MAILING ADDRESS: jo /15([ STATF:'�ZIP: o
RlNif A TT ,�. ii �7 / rVi,:. 1._& 1Pe r W M AX
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 F
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP,
PHONE #: Home (
Work ( ) Cell (
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE
How manv buildinLys are located on this property?
Did you recently purchase this property Yes (If yes, list previous owner's name)
Is this a lot split? c' 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.
J
DwneVl pffees icant DATE
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
are non - refundable and are paid in full at the time of application beginning January, 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**
0 •
Bui
19 E. Main
Rexburg, ID 83440
ng Safety Department
City of Rexburg
janellh@rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
CITY OF
REXBURG
._ rw __ --
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 basemen area ;
Third floor /loft area Garage area /l•'
Shed or Barn Carport /Deck (30" above grade)Area 14! S�
Water Meter Quantity:
* * * * * * * * * * * ** *Water Meter Size:
Required Y
PLUMBING
Plumbing Contractors Name: Business Name:
Contact Phone: (
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub /Spa
Sinks (Lavatories, kitchens,
Plumbing Estimate
Signature of Licensed Contractor
The
scbedule is the sa me as required by the State
Date
F
City
Phone: (
y exau gc
r, r4
O
ro
Sprinklers
Tub /Showers
Toilet /Urinal
Water Heater
Softener
mop)
(COMMERCIAL /MULTI - FAMILY ONLY)
License Number& Expiration Date
Bull
Safety Department
City of Rexburg
19 E. Main
Rexburg, ID 83440
ionellh @rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
`yc aExevgr t'
U O
C I T Y OF
RE
Americas Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
Name Address
e Yb u�'
c i t y
Being first duly sworn upon oath, depose and say:
- 2"e�c)
State
(If Applicant is also Owner of Record, skip to B)
A. That I am the record owner of the property described on the attached, and I grant my
permission to:
Name
Address
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulting from any dispute as to the statements contained herein or as to the
ownership of the property which is the subject of the application.
Dated this 4 ` — / ` �d ` / W L day of — '20 0
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires: