HomeMy WebLinkAboutAPPLICATION - 04-00265 - 267 Apache Ave - Basement RemodelCITY OF REXB URG PERMIT #
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
PARCEL NUMBER:
SUBDIVISION: �� (((,� UNIT# BLOCK# LOT#
OWNER: L - e ,C CONTACT PHONE # 311
1 01 1 10
PROPERTY ADDRESS:
PHONE #: Home ( 61) - ol,2_() Work (2 r -6) L �,- C)se6 u � Cell (9tJ 317 tc��c
OWNER MAILING ADDRESS: y Lj &-, a_(,V %� CITY:
STATE: ZIP:
APPLICANT (If other than owner)
(If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
MAILING ADDRESS OF APPLICANT
CITY:
PHONE #: Home ( )
Work (
STATE:
Cell (
CONTRACTOR: �' i� PHONE: Home# Work#
MAILING ADDRESS:
How many houses are located on this property?
CITY
ZIP_
Cell#
STATE ZIP
Did you recently purchase this property? No Ye (If yes give owner's name) t-VIJ �A �
Is this a lot split? NO
PROPOSED USE:
(i.e., Single Family
YES (Please bring copy of new legal description of property)
Multi Faxlily, Apartments, Remddel, 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 2000 International Code in cases of any false
statement or isrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started Wit Kin 180 days. w Permit oid if st s for 180 days.
`
Signature of Owner /.
T / 1 I 1 - 0 tt
DATE
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 January 1, 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 you check does not clear **
I
NANM i eel
PROPERTY ADDRESS ,
SUBDIVISION Pty` ao �1 � N ,
Dwelling Units:
Parcel Acres:
Front Footage (if applicable)
Unfinished Basement area /Y 7L
Finished basement are �57b
Garage area .5zi
Carport/Deck (30" above grade)Area
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area
Second floor /loft area
Third floor /loft area
Shed or Barn ---
PLUMBING
PLUMBERS NAME
CITY
§n '!�' ADDRESS
STATE ZIP PHONE (
FIXTURE COUNT Q
CLOTHES WASHING; MACHINE 0 SPRINKLERS 0
DISHWASHER 0 TUB /SHOWERS 1
FLOOR DRAIN 0 TOILET/URINAL
GARBAGE DISPOSAL i WATER HEATER
HOT TUB /SPA 0 WATER SOFTENER
SINKS
(Lavatories, kitchens, bar, mop)
WATER METER COUNT WATER METER SIZE
HEAT (Circle all that apply Ga Oil Coal Fireplac ~ `'Electric
Commercial Buildings & _Apartments with 3 or more units Only
BUILDING ESTIMATE $
PL UMBING ESTIMATE $
STORM WATER LENGTH
FRONT FOOTAGE
STRUCTURES
DESCRIPTION
USE
BEDROOMS
UNITS
NON CENSUS
OCCUPANCY LOAD
EXITS
SETBACKS
FRONT SIDE SIDE
CONSTRUCTION
ROOF
Permit#
SANITATION METHOD
HEAT
FLOOD ZONE
FENCE TYPE
OCCUPANCY
BACK
2