HomeMy WebLinkAboutAPPLICATION - 04-00374 - 256 S 3rd W - RemodelCITY OF REXB URG PERMIT # O el e e92
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440 D E C E 0 U E
208 - 359 -3020 X326 /�
O �� Y' 3 n OCT 1 2 2Q04
PARCEL NUMBER: o
SUBDIVISION: UNIT# BLOC
OWNER: hf i s n o, J0;4 lJ o 1 m aw CONTACT PHONE # `-
PROPERTY ADDRESS: 5 L S 3rd W U rQ 'Aga
PHONE #: Home Work( ) Cell ( )
OWNER MAILING ADDRESS: S a4 n e , CITY: STATE: ZIP:
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 ( (, y) 3 5 4 _ z , 9 Work (
STATE; ZIP
Cell ( )
CONTRACTOR: PHONE: Home# Work#
MAILING ADDRESS: CITY
How many houses are located on this property?
Did you recently purchase this property? 00 Yes (If yes give owner's name)
Cell#
STATE ZIP
Is this a lot split? WO YES (Please bring copy of new legal description of property)
PROPOSED USE: & A e Oe " :J:: An a r fm Ph J • Lw
(i.e., Single Family Residence, Multi Family, Apartments, Remodel,
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 1 . Permit void if wgfk stops for 180 days.
of Owner /Applicant
CITY:
�� /Z / o 4
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 **
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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 Unfinished Basement area
Second floor /loft area Finished basement area
Third floor /loft area Garage area
Shed or Barn Carport/Deck (30" above grade)Area
Remodel (Need Estimate) $ S aco
PLUMBING
PLUMBERS NAME
CITY
STATE ZIP
FIXTURE COUNT
CLOTHES WASHING MACHINE
DISHWASHER
FLOOR DRAIN
GARBAGE DISPOSAL
HOT TUB /SPA
SINKS
(Lavatories, kitchens, bar, mop)
WATER METER COUNT
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 & 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
CONSTRUCTION
ROOF
SANITATIONMETHOD
HEAT
FLOOD ZONE
FENCE TYPE
OCCUPANCY
BACK
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