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HomeMy WebLinkAboutAPPLICATION & PLANS - 04-00353 - Office/Pharmacy - RemodelCITY OF REXB URG BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208 - 359 -3020 X326 SUBDIVISION: UNIT# BLOCK# PERMIT # OWNER: CONTACT PHONE # --6S 3� PROPERTY ADDRESS: 2 3 2 C. PHONE #: Home ( OWNER MAILING ADDRESS: Work ( APPLICANT (If other than owner) f (,�� 1 ( L- - E `T FC�d (If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) MAILING ADDRESS OF APPLICANT 1`x.3 6 r. g©o/V , CITY: /�"- 4 ' STATE; �` ZIP 3 5 PHONE #: Home ( (22 q -79'52 Work (2,0 �. -G,S�y Cell (?off 2o 7— CONTRACTOR: GeAko ��Vcl PHONE: Home # Work# C 2+W% Cell# 3 1 7 -6 7 p MAILING ADDRESS: 1 7 F. L/00 Al CITY _S STATEZIP How many houses are located on this property? &0 A/ Did you recently purchase this property? No es If yes give owner's name) Is this a lot split? NO YES (Please bring copy of new legal description of property) PROPOSED USE: (i.e., Single Family Residence, Multi Family, Apartments, Remodel, LOT# ition, 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 i� work stops for 180 days. Signature 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" Cell ( ) CITY: STATE: ZIP: 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 k Finished basement area Garage area A ZA Carport/Deck (30" above grade)Area //f}- FIXTURE COUNT STATE ZIP ADDRESS PHONE( CLOTHES WASHING MACHINE - SPRINKLERS DISHWASHER — TUB /SHOWERS FLOOR DRAIN _� TOILET/URINAL / GARBAGE DISPOSAL WATER HEATER HOT TUB /SPA WATER SOFTENER SINKS (Lavatories, kitchens, bar, mop) WATER METER COUNT WATER METER SIZE BUILDING ESTIMATE $ PLUMBING ESTIMATE $ °2 50, STORM WATER LENGTH FRONT FOOTAGE STRUCTURES DESCRIPTION USE ]�i►y►'��9 �C i / ,� '� ©i ee BEDROOMS CONSTRUCTION ctto& - UNITS ROOF NON CENSUS SANITATIONMETHOD OCCUPANCY IOAD HEAT 04 EXITS 'L FLOOD ZONE SETBACKS FRONT SIDE SIDE FENCE TYPE OCCUPANCY BACK 2 HEAT (Circle all that apply Gas Oil Coal Fireplace r' 3G if x 30 band icop Par Piopo5e Pe5froo for Valley Profe55ional Phol-mocy P Id 8�544�3 2 too YV~ . ITe51 �oor� X611 x 011 handicap P ar rc)v- A car--uc�vgNie- �r , rA gP 11, l 11 2 i 1=row Reef 5forage flood Room Dr Jefferes Of Jeffer ;es 1. V' Room # 3 Room # 2 Room Office Ink Reef i Room Purrrc Room 8' S Drive Up 3 2� ff Office Display Or Jeffer ;ems /f eo Room # I J'harmacy hea g, 3'-4„