HomeMy WebLinkAboutAPPLICATION - 04-00268 - 102 K St - Remodelr CHY OF REXB URG PERMIT #
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208- 359 -3020 X326
PARCEL NUMBER:
SUBDIVISION:
e
p
UNIT# BLOCK#
LOT#
OWNER:
C �`��
pt;,
ONTACT PHONE # 3�� "
(� 0 � Q
PROPERTY ADDRESS: )o L_
r
PHONE #: Home ( ) 3 �t � Lt J 6 Work
Cell ( ) 76
OWNER MAILING ADDRESS: 16 L IL Sf CITY: �e STATE: ZIP: 0 3 d
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 r >
l 6 L IL S +R CITY: STATE; L ZIP
PHONE #: Home ( ) 3 rG o 1 Work ( ) 7_ Cell( ) 7 Qq — (D q �?
CONTRACTOR:
PHONE: Home# Work# Cell#
MAILING ADDRESS:
CITY
STATE ZIP
How many houses are located on this property? k c_
Did you recently purchase this property. No )Yes (If yes give owner's name)
Is this a lot split? a YES (Please bring copy of new legal description of property)
PROPOSED USE: (Ze fNA f-I ch
(i.e., Single Family Residence, Multi
fi�- �_ S q-. K(?fjm t P1
y, 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 2000 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.
'Applicant
_ X10
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 **
NAME "[Pk �-- (' h P oA t
PROPERTY ADDRESS I P-4 b
SUBDIVISION r- , A (. 2
Dwelling Units
Parcel Acres:
Front Footage (if applicable
SURFACE SQUARE FOOTAGE
First Floor Area
Second floor /loft area
Third floor /loft area_
Shed or Barn
PLUMBING
PLUMBERS NAME
CITY
FIXTURE COUNT
CLOTHES WASHING MACHINE
DISHWASHER
FLOOR DRAIN
GARBAGE DISPOSAL
HOT TUB /SPA
SINKS
(Lavatories, kitchens, bar, mop)
WATER METER COUNT
ZIP
ADDRESS
PHONE(
SPRINKLERS
TUB /SHOWERS
TOILET/URINAL
WATER HEATER
WATER SOFTENER
WATER METER SIZE
HEAT (Circle all that apply) Gas Oil Coal Fireplace Electric
Commercial Buildings & A partments with 3 or more units Only
BUILDING ESTIMATE $
PL UMBING ESTIMATE $
STORM WATER LENGTH
FRONT FOOTAGE
STRUCTURES
DESCRIPTION
USE
BEDROOMS
UNITS
NON CENSUS
OCCUPANCY ZOAD
EXITS
a, `,0
(Shall include the exterior wall measurements of the building)
b ti,,1 d," — 3 ( X Sb
Unfinished Basement area
Finished basement area I fob
Garage area
Carport/Deck (30" above grade)Area S60
STATE
SETBACKS
FRONT SIDE SIDE
Im
CONSTRUCTION
ROOF
SANITATION METHOD
HEAT
FLOOD ZONE
FENCE TYPE
OCCUPANCY
BACK
Permit#
2