HomeMy WebLinkAboutAPPLICATION - 04-00433 - City of Rexburg - Fire Department - RemodelCITY OF REXB URG PERMIT #
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440 If 0 loll •
208 - 359 -3020 X326 able
PARCEL NUMBER: DepartulenFlre
SUBDIVISION��: / uivlr# BLOCK# LOT#
OWNER: `f' ® k71,� Y-� CONTACT PHONE # 30
PROPERTY ADDRESS:
PHONE #: Home ( ) Work ( ) Cell
OWNER MAILING ADDRESS: CITY: STATE :
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: STATE; ZIP
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR: ��,� PHONE: Home# Work# Cell#
MAILING ADDRESS: CITY STATE ZIP
How many houses are located on this property?
Did you recently purchase this property?(9 Yes (If yes give owner's name)
Is this a lot splitz
YES (Please bring copy of new legal description of property)
PROPOSED USE: ' 42 C , r -/;, ( �_ C
(i.e., Single Family Residence, Multi Family,
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 pr visions of the 2000 International Code in cases of any false
statement or misrepresentation of fact in the application or on the s on which the permit or approval was based. Permit void if not
started within 180 days. stop � 180 da
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
PROPERTY AbbREgS . ✓� Permit#
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT �2 - 3 SIDE / -4, SIDE Z(, BACK 3
Front Footage (if applicable)
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area �� -, f,
Second floor/loft area
Third floor/loft area
Shed or Barn
Garage area
Carport/Deck (30" above grade)Area
Remodel (Need Estimate) $ 0c5 tD
PLUMBING
PLUMBERS NAME
CITY
FIXTURE COUNT
CLOTHES WASHING
DISHWASHER
FLOOR DRAIN
GARBAGE DISPOSA:
HOT TUB /SPA
SINKS
(Lavatories, kitchens, b
WATER METER COUNT
STATE ZIP
ADDRESS
. PHONE ( )
SPRINKLERS
TUB /SHOWERS
TOILET/URINAL
WATER HEATER
WATER SOFTENER
WATER METER SIZE
HEAT (Circle all that apply Ga Oil Coal Fireplace Electric
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)
Unfinished Basement area
Finished basement area
2
0400433
Fire Department