HomeMy WebLinkAboutAPPLICATION - 08-00466 - 500 Rolling Hills Dr - Water Heater - CANCELED. A 11- PERMIS
BUILDING PERMI APPLICATION Pleasf
19 E MAIN, REXBURC}, ID, $3440 If the qu 08 00466
208 - 3593020 X322
PARCEL NUMBER }� T 500 Rolling Hills Dr -Water Heater
SUBDIVISION,
(Addressing is based' on the - Woraaation - must be amurate)
0 CONTACT PHONE #
PROPERTY ADDRESS; �/17) P J-R, 1L ® Dr i1 ,
PHONE #; Hoinc ( ) Worl ( ) Coll ( )
OWNER MAILING ADDRESS: CITY; STATE: ZIP:
EMAIL FAX
L (If other than own , than owacr, a statemam aur}totiz{ng applicant to act as agent for ownner must accompany this application.) NFORMATION: ADDRESS CITY ZIP c EMAIL FAX e ( ) Work
Ct7NT.RAC7'O.�Y:
L
MAILIN4 ADDRESS: f/ Sac 'd - CITY J .5 STATE ZIP
PHONE: Home# Work,# 811#
EMAIL FAX
How nmuy builtiiugs are located on this pmpercy?
Did you recently purehase this propcM? No Ya (Ifyc9 give owner's name)
Is this A lot split? NO YES (Pk-= bring copy of new legal description of property)
PROPOSED USE.
(Le., SkWe FaWly Itesida wo, Mold Family. Apatitaents, Remodel, Garage, Commercial, Additlon, Eta.)
A:PPLICAiNT'S SIGNATURE, CERTIFICATIONANDAUTHO ttnderpeesltyaipetjury ,Ihete6y,certltyrhatl
We iced tkh 00cado and state tbw The k6nmdon hWWQ is ognWt and l>»aarIW M infUMkotro W)da r May,h ae8a Na *an by ran in heerimp before the
Plenelhg sadzoafu COMEWRIon otiho Citycau uqd hr the City otRabwSxhall be truzhu and cacrecr. I agree to comply with all City rsse]arlow end Stare lawn
rolalrog b Ilia subJect tDalsar of4hia appiieation mrd hereby aurpDria�td repreeeftU&N Ortftl ChYTO eats IWA the abovt n a cncd pmporty furimpmdom ptawscu,
NOTE The building o.fficW may revoke a permit an approval issued undarhe paoviaims ofthe2000 Iarnnt dmW Code in aruw af>myfolae 496maot or-
sops t w een�lon ] 80 days. offaorla the aDp$cezlon or on tin plane on whiab the permit orapprvvel was bwcd, Permit void i(.w1sWted wiutA 180.days. Pe nitvoid irwerk
Dope Or ,
Sigpattae Owner A DA
7 � z d; TB
Do you prefer to be contacted by fax, email or phone? Circle Ono
WAMMrz— MM -DING PUMITMUSTIM POSTED ON 0-ONBTRUMONI31=
Plan hu are nea,raftdal le and are paid h%f W Oft-fie ut opp4eWon bp&uW
Clay ail thwl's Azceptana of the plan renew fee deu not canalEiota p>an approral
3
"BuIldift Porallow doe Af lima o }opygeatloa�� 0 *20a apormlo id If you cheat
PYease complete the entire Application!
If the queetlon does not appJ► IM !u NA for non applicable
NAME
PROPERTY ADDRESS Pencdt
SUBbIVIS10N
Dwelling Units; Penal Acres:
SETBACKS
FRONT SIDE SIDE BACK
Rmodding Your BrdidittglHome (need Estimatc) $
SURFACESQUARTs FOOTAGE. (Shell inolude the exterior wall moasumnents of the
lot
First Floor Area UnUshed Basement area
Second floor /loft area Finished basement area
Third floor /loft wc — Garage area
Shed or Hera Cagvrt/Deck (30" above exade)Area _
Water Motor Coast: � Water Mater Size:
Requiredll
PL UMBING
Plumbing Contractor's Nme; ?IAJ — B usiness Nam:
Addre caity to Zip
- � --
001 Phono. ( ) S �� �7 r;�; A usims ]Phone: (
Email
�rzu� Cvr, r�rn���ia��c�d�t6t�t
Clothes Wuhing Machin
Dishwasher
Floor Drain
Owbagc Disposal
Hot Tub/Spa
Sprinkles
Tub /Showers
Toilet/urtnW
^� Water Heater
Water Soflcner
.�_ Sinks
(Lavatories, kitchens, bar. mop)
Plumbing Es ate S - (Commercial Only)
�2 /,p>-
Ro9i�clredl 3lgnanire
of Licensed Contractor Liceme aunaber
- � Tho Ctry ofRexDarg's permit fes schedule la rhs samm as
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by Ike ,�aate ldah
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