HomeMy WebLinkAboutAPP & PLANS - 04-00271 - Central Storage - AdditionCITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
PARCEL NUMBER:
SUBDIVISION:
0400271 Allen
Storage Units 344 W 4 S
UNIT# BLOCK# LOT#
OWNER: 4- C� o f iC CONTACT PHONE # 7q
PROPERTY ADDRESS:
PHONE #: Home ( ) 7q5-- Work (
OWNER MAILING ADDRESS: 39 E, yon /j, CITY: i #4 STATE IP ZIP: g 3 V V
PHONE NUMBER: HOME# ( ) WORK# )
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:
CONTRACTOR:
STATE; ZIP
PHONE: Home# Work#
MAILING ADDRESS:
CITY
STATE ZIP
How many houses are located on this property? I Jrke b L4 i 'n , ? 4 S�o r �U IJ A im
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? 1� YES (Please bring copy of new legal description of property)
PROPOSED USE: S
(i.e., Single Family Resi(
Family, Apartments, Remodel, Garage, 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 representative of thie City to enter upon the above - mentioned property for inspections purposes. I agree to comply
and understand that it is my responsibility to determine the proposed development of the property listed fully complies with the
applicable regulations. 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
of Owner /Applicant
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
PROPERTY ADDRESS
SUBDIVISION lt/{�
Dwelling Units:
Front Footage ( )
Parcel Acres:
Permit
SURFACES: (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 l A� � ADDRESS
CITY STATE ZIP PHONE (
FIXTURE COUNT
CLOTHES WASHING MACHINE
DISHWASHER
FLOOR DRAIN
GARBAGE DISPOSAL
HOT TUB /SPA
SINKS
(Lavatories, kitchens, bar, mop)
WATER METER COUNT
SPRINKLERS
TUB /SHOWERS
TOILET/URINAL
WATER HEATER
WATER SOFTENER
WATER METER SIZE
HEAT (Circle all that apply) Gas Oil Coal Fireplace Electric
Commercial Buildings & Apartments with 3 or more units Only
BUILDING ESTIMATE $
PLUMBING ESTIMATE $
STORM WATER LENGTH
FRONT FOOTAGE
Unfinished Basement area
Finished basement area_
Garage area
Carport/Deck(30 ")Area
Ask Val about Structures
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Central Storage 1
344 W 4 S
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