HomeMy WebLinkAboutAPPLICATION - 04-00386 - Brookside Village - PlumbingCITY OF REXB URG PERMIT #
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
PARCEL NUMBER:
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
SUBDIVISION:
OWNER: 00,SC -1 CONTACT PHONE # U9 9P `f LI S
PROPERTY ADDRESS: Lf ?, q S. 2, w. A'q
PHONE #: Home o ) Sri qYe/
OWNER MAILING ADDRESS:
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
.SA4w? CITY:_
PHONE #: Home ( ) Work
CONTRACTOR:
Work ( ) Cell �5 `� `t S Z
UNIT# BLOCK# LOT#
STATE; ZIP
Cell ( )
PHONE: Home#
MAILING ADDRESS:
Work# Cell#
CITY STATE ZIP
How many houses are located on this property? 6 Ulll k— WLi V 4w,,!
Did you recently purchase this property ? Yes (If yes give owner's name)
Is this a lot split? (L�;D YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, 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 rev it on approval issued under the provisions of the 2000 International Code in cases of any false
state nt or misre entation of act in the application or on the plans on which the permit or approval was based. Permit void if not
startVd w,j�jin 1 days. Permit y6id if work stops for 180 days.
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 M& 1006 PLO p 5
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units: Parcel Acres:
Front Footage (if applicable)
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) $
Unfinished Basement area
Finished basement area
Garage area
Carport/Deck (30" above grade)Area
PLUMBING
PLUMBERS NAME &(3L PLuwx9.i ADDRESS
CITY STATE 14. ZIP PHONE (load) SZ - �lyy
FIXTURE COUNT
CLOTHES WASHING MACHINE
DISHWASHER
FLOOR DRAIN
GARBAGE DISPOSAL
HOT TUB /SPA
SINKS
(Lavatories, kitchens, bar, mop)
WATER METER COUNT
WATER METER SIZE
HEAT (Circle all that apply) Gas Oil Coal Fireplace ec
Commercial Buildings & Apartments with 3 or more units Only
BUILDING ESTIMATE $
PLUMBING ESTIMATE $ Z, o�
STORM WATER LENGTH
FRONT FOOTAGE
DESCRIPTION
USE
BEDROOMS
UNITS
NON CENSUS
OCCUPANCY IOAD
EXITS
SETBACKS
FRONT SIDE SIDE
CO SPRINKLERS
TUB /SHOWERS
TOILET/URINAL
WATER HEATER
WATER SOFTENER
CONSTRUCTION
ROOF
SANITATIONMETHOD_
HEAT
FLOOD ZONE
FENCE TYPE
OCCUPANCY l
BACK
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