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HomeMy WebLinkAboutAPPLICATION - 04-00372 - 370 S 3rd W - Remodelcrr-Y OP REXBURG N BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208- 359 -3020 X326 PARCEL NUMBER: SUBDIVISION: UNIT# BLOCK# LOT# OWNER / � CONTACT PHONE # - 3 PROPERTY ADDRESS: CITY:_ Work PHONE #: Home �?o5) - 3 �5_ _68( Work _ p Cell OWNER MAILING ADDRESS: S �`�� CITY: STATE.2ZIP: 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 PHONE #: Home ( CONTRACTOR: MAILING ADDRESS: How many houses are located on this property? CITY Cell# STATE ZIP 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: (i.e., Single Family PERMIT # Please complete the entire Application! If the question does not apply fill in NA for non applicable ' k C4 STATE; ZIP Cell ( ) tcesiaence, Multi ramily, 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 st with 180 days it void if work stops for 180 days. of PHONE: Home# Work# 4 � 1 _ 1 _ 6 _ L � DATE WARNI1dG — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! 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 Z� cd y? �. ■ PROPERTY ADDRESS 3 2e mi a P,1 Ltl SUBDIVISION Dwelling Units: SETBACKS FRONT Parcel Acres: SIDE SIDE Front Footage (if applicable) 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 L p U 5 S ��i ADDRESS CITY STATE _ ZIP $311y0 PHONE ( ) o FIXTURE COUNT CLOTHES WASHING MACHINE / SPRINKLERS DISHWASHER TUB /SHOWERS FLOOR DRAIN _� TOILET/URINAL p— GARBAGE DISPOSAL WATER HEATER 19 HOT TUB /SPA WATER SOFTENER SINKS (Lavatories, kitchens, bar, mop) WATER METER COUNT HEAT (Circle all that apply) Gas Oil Coal Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area WATER METER SIZE Fireplace Electric L{/ ©o d Commercial Buildings & Apartments with 3 or more units Only PLUMBING ESTIMATE $ STORM WATER LENGTH FRONT FOOTAGE STRUCTURES DESCRIPTION USE BEDROOMS (If Applicable) APT. UNITS (IfApplicable) OCCUPANCYLOAD TYPE OF CONSTRUCTIONAS PER IBC_ ROOF CLASSIFICATION HEAT TYPE FLOOD ZONE OCCUPANCY (As Per IBC) l Permit# () y `C) D j 7 :•W1 P? . I r + CITY OF REXB URG PERMIT # BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208 - 359 -3020 X326 PARCEL NUMBER: � P R c P 0 I D 4� I Ih SUBDIVISION: UNIT# BLOCK# LOT# OWNER: Dea ti1 6 , �, r Z- JJ C Gil S 04 CONTACT PHONE .5 (0 - PROPERTY ADDRESS: 5 J �3 o_) PHONE #: HomeZf 5) -3 S& lgf l y Work (A 4q6 - 16 9 Cell ( ) ---- OWNER MAILING ADDRESS: Z7 6 5 3 tc) CITY: E sc STATE r ZIP: 9� q Ve 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 PHONE #: Home ( CITY: Work ( STA Cell ( ZIP 3SC `7 CONTRACTOR: tu/s J�/I J� h PHONE: Home# Work# — Cell# - MAILINGADDRESS IIV CITY /4_h STAT ZIP How many houses are located on this property? Did you recently purchase this property? (�O) Yes (If yes give owner's name) Is this a lot split? @0)) YES (Please bring copy of new legal description of property) PROPOSED USE: (i.e., Single Family Multi F , 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. 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 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 (sG'C� /�S ���� h ADDRESS 77 ,-,',. Al- CITY STATE ; ZIP (-zo j -:� S(, - '7 (,y 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 WATER METER SIZE Coal ireplace lectri j 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 ZOAD EXITS SETBACKS FRONT SIDE SIDE G— 00 n Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area SPRINKLERS TUB /SHOWERS TOILET/URINAL WATER HEATER WATER SOFTENER CONSTRUCTION ROOF SANITATIONMETHOD HEAT FLOOD ZONE FENCE TYPE OCCUPANCY BACK 2