HomeMy WebLinkAboutAPPLICATION - 16-00045 - 164 W 1st N - AT&T Tower Addition,io ¢E1tlUge,,'
CITY OF
1EG Please Complete the Entire Application!
'a If the question does not apply fill in NA for nomapplicable
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America's Family Community / U
COMMERCIAL & MULTI FAMILY BUILDING PERMIT APPLICATION I G_ �QO ! s
35 N I" E, REXBURG, ID 83440
208-359-3020
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
Addressing is based on the information - must be accurate
OWNER NAME: f_ IAIJrde E4F*',*7Z?XS /NC CONTACT PHONE # Z08 •.356' :4".531
PROPERTY ADDRESS: liea7_ /Jl-,rt Ajda! al"35/X0
PHONE #: Home Work Cell
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL
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APPLICANT (If other than owner) ®oMP&-Z AlRiFe e06Y94p01dWVr Jrea rr Af-Ro'
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION:
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STATE, /O ZIP
OCS6/6
EMAIL seat-t;OypCa�oow ✓erc/t✓ Cow`
PHONE #: Hist
WorkZOR
9�8.88.%iCell
ZO8. 97.? • 9969•
CONT]?ACT012: Tighto Ta-gue cok1g1-iZUP.Tiowl
MAILING ADDRESS: CITY STATE ZIP
PHONE: Cell# Zn8'• 011 • I2 Z6 Work# Fax#
EMAILID O REGISTRATION # & EXP. DATE
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How many buildings are located on this property? 1
Did you recently purchase this property? O'NO ❑ YES
(If yes, list previous owner's name)
Is this a lot split? O'�O ❑ YES (Please bring copy of new legal description of property)
PROPOSED USE: PJ/fPEL& S7 comm FAci zy flQCnlCf' A F.etJ,
(ic., Single Family Residence, Multi FarrWy, Apartments, Remodel, stage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under pcmlty ofpcqury, I hereby ccrdfy, that I
have read this application and state that theinformation herein is correct and 1 swear that any information which may hereafter be given by me in hearings before the
Planning and Zoning Commission or the City Cound for the City of Rexburg shall be truthful and correct. I We 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 2003 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 Lapps for; SO days.
Signature 670wner/A' ' an —
Do you prefer, to bt contacted by fax, email or phone?
4C PERMIT MUST BE POSTED ON CONSTRUCTION SITEI
.it arc paid is Satin the rime of.pp icad.n beginningJA W{Vi