HomeMy WebLinkAboutAPPLICATION - 08-00542 - 485 N 2nd E - Deseret BookstoreNov. 5. 20087 4;18PM1;[1 F rst Call Jewel No. 25415 P. 1'
CITY OF'REnUR* PERIMIT# 0 3 -,/
BUILDINGPERMITAPPLICATION Please complete the entire A pplication!
19 E MAIN, REXBURG, ID, 53440 If the question does not apply kill in NA for non applicable
208-359-3020 X322
PARCEL NUMBER: ( We will provide this for you)
SUBDIVISION; UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
PROPERTY ADDRE
PHONE #: Homc (
OWNER MAILING ADDRESS: CITY: STATE: ZIP;
EMAIL FAX
APP ; (If other than owner) � 4W e.�
e
(Applicant if other than owner, a staremant authorizing appboam to act as agent for owner must accompany
APPLICANT INFORMfLTION: ADDRESS I 67ygd CITY: Z44 - 4t&5
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) .� - 2 77 ? Call ( )
CON?'.RACTOR
MAILING ADDRESS:
PHONE: Rome#
CITY-9/ r 0 5 STATF, 3
Work# Call#
EMAIL
,How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
ox,, S,ilrgle Family Residence, Multi Fa illy, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANNT' S SIGAlATURE, CERTIFICATI0AN AND AUTHORIZATION Under penalty of papery, I h—V =:* that I
have irad this applicadoa and strati"du iaforroadtin horoia is ovnwt and 1 aWcV that pay iuformelion whiob may ficmA r ba; van by me in heerinps before the
PlannJng and Zaalgg Commlasion ortho City Coim6J.for the City ofRexbwg shell be trulbU and coffee t ag ea to comply with a ll City regulations and Stale laws
01*36 to 1119 subject manor of thle appliMton and hMby 0111110"d repreeeeraUM U1110 City to enter upon the above- mantioncd proputy for Ingpecdons purposes.
NOTE: The building official may ravoke a permit on approval imed under the ptovislow of tart: 2000 Intamadonal Codo in aria+ of wY false rwiUmt or
misnptemraaon of Wc.la the SpplicWon or on dm plans on which tho perroit or approval was based, Permit voJd Knot s"d within 180 days_ Permit void if Work
stops for 180 days. , r
/ / / �_
DATE
Do you profer to be eoatactcd by fax, email or phone? Circle One
WAAMC – W=ING PERMIT MUST SE POSTED ON CONSTRUCTION SrITI
Plan ibex are con- rafuatiable and are pale hLMO at tho limo of epP1148don boonniog 1, 3 06
Oty ofResbarg's Acreptemes of the p" review in dons not constitute plan approval
,(�_oJ 4<r9-a�l/� _C v , CONTACT PHONE #
Nov. 5. 20081 4:18PM)r First Call Jewel "'No, 2541 r ' P. 2
• 0
Buliding Safety Department •
city of Rexburg
19 E M& 1ane11h6rexburg.orp Phvno :909,950,3020 x526
Rexbvrg, ID 99440 www,rexbUto.org Fox. 200.359.SD24
CITY or
REXBURG
AmerlcA hinily CoMmwdy
OWNER'S NAM
PROPERTY ADDRESS Pemlit#
SUBDIVISION
PHASL LOT BLOC
Requ redffl
Electdcai c ontiracctoes Nome
Addreas t 96-"0 —q- q
a Name
Cell Phone ( ) B ualnees Phone( ) e LaZa -- Z 7 7 7
pax( )
Electrlc111 Eatimatc (cos[ of wlriag & labor) (COMMERCIAL /lAULTI- FAMILY ONLY)
ryas oplMAL"
(Now,Resldanrialladudes vmgddgr oowm&e Wld dh the teddeptdd e0udum and Art ah&d bzgp at the s ome dma)
Up to 200 amp Service"`
201 to 400 amp Sorvica'O
Over 400 amp Service*
Temporary Construction Service, 200 amp or lees, one locadou (for a pedod 1109 to exceed 1 year)
Existing Resideatial (# of Branch Circuits)
Spa, Hot Tub, SVritnming Pool
Flectric Central Systems Heating and /or Cooling (when not part of it now reddendal construction pewit
sad no additional wWat
Modular, Manufactured or Mobile Home
OtheF Installations: Wlring not specifically covered by any of the above
Coot of Wiring & Labor: 3
Pumps (Domestic Watet, Irrigation, Sewage)
Requested Inspections (of existing wldno
Temporary Amusement /Industry
*Includes a mmlm= of 3 io.pecdons. Additional inspcctiom charged 4t tequested inspection rate of $40 per hour,
Zdmt 4 ..2 az=
SiSnatute of Licensed Contesuol Uocme number Dso
Tht
ELECTRICAL
lehedwb it the ran► 4r ngahr /' As Si dte