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Home My WebLink AboutAPPLICATION - 04-00348 - 165 N 3rd E - RemodelCITY OF REXB URG BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208 - 359 -3020 X326 PARCEL NUMBER: SUBDIVISION: mm.1 PERMIT # BLOCK# LOT# OWNER: 1 ,A ?A8 7 E- CONTACT PHONE # PROPERTY ADDRESS: its E PHONE #: Home ( ) Work ( OWNER MAILING ADDRESS: CITY: STATE: ZIP: APPLICANT (If other than owner) / y l ' ke- ` tF�i zC }.} (If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) MAILING ADDRESS OF APPLICANT Z`t q N Z1 00 c CITY: S e AKTf l-4cvJ�fS ZIP PHONE #: Home ( ) Work ( ) Cell ( ) CONTRACTOR: - I G14 — PHONE: Home# Z) db TWork# Cell# 7Ca'71, MAILING ADDRESS: How many houses are located on this property? CITY 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: 1JLkyl �j (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, C mmercial, Addition, 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. Perrn d` f work stops for 180 days. Signature of Owner /Applicant Cell ( ) STATE ZIP �i 23 / off 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 Dwelling Units: Front Footage (if applicable) Parcel Acres: Permit# 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 Remodel (Need Estimate) $ PLUMBING PLUMBERS NAME CITY Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area STATE ZIP FIXTURE COUNT CLOTHES WASHING MACHINE DISHWASHER FLOOR DRAIN GARBAGE DISPOSAL HOT TUB /SPA SINKS (Lavatories, kitchens, bar, mop) WATER METER COUNT HEAT (Circle all that apply) Gas Oil Coal Fireplace Electric Commercial Buildings & BUILDING ESTIMATE $ PLUMBING ESTIMATE $ STORM WATER LENGTH_ FRONT FOOTAGE STRUCTURES DESCRIPTION USE BEDROOMS UNITS NON CENSUS OCCUPANCY LOAD EXITS SETBACKS FRONT SIDE 3 or more uni; 14 )(3:;L ADDRESS PHONE ( SPRINKLERS TUB /SHOWERS TOILET/URINAL WATER HEATER WATER SOFTENER WATER METER SIZE CONSTRUCTION ROOF SIDE SANITATIONMETHOD_ HEAT FLOOD ZONE FENCE TYPE OCCUPANCY / BACK 2 CITY OF REXBURG BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208 - 359 -3020 X326 PARCEL NUMBER: SUBDIVISION: PERMIT # UNIT# BLOCK# LOT# OWNER: CA11 /fa / CONTACT PHONE # PROPERTY ADDRESS: S PHONE #: Home ® 7�y - �� Work Cell( ) OWNER MAILING ADDRESS: "_/.�� CITY: STATEZIP 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 ( CONTRACTOR: PHONE: Home# Work# Cell# MAILING ADDRESS: CITY STATE ZIP How many houses 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: bob z m 2404, (i.e., Single Family Reside ce, Multi FaWly, Apartments, Remodel, (Tarage, ComrAercial, 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. of Owner /Applicant / 1 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" STATE; ZIP Cell ( ) NAME PROPERTY ADDRESS SUBDIVISION Dwelling Units: Front Footage (if applicable ADDRESS PHONE( Parcel Acres: 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 Remodel (Need Estimate) $ PLUMBING PLUMBERS NAME CITY Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area STATE ZIP FIXTURE COUNT CLOTHES WASHING MACHINE DISHWASHER FLOOR DRAIN GARBAGE DISPOSAL HOT TUB /SPA SINKS (Lavatories, kitchens, bar, mop) WATER METER COUNT Permit# F 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 STRUCTURES DESCRIPTION USE BEDROOMS UNITS NON CENSUS OCCUPANCY LOAD EXITS SETBACKS FRONT SIDE CONSTRUCTION ROOF SANITATIONMETHOD HEAT FLOOD ZONE FENCE TYPE OCCUPANCY l SIDE BACK 2