HomeMy WebLinkAboutAPPLICATION - 16-00016 - 1085 Greenside Loop - ShopCITY OF
REXBURG
Ow -
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Please Complete the Entire Application!
If the question does not apply fill in NA for non applicable
RESIDENTIAL BUILDING PERMIT APPLICATION
35 N Ist E, REXBURG, ID 83440 16 oc/0 16
208-372-2326
PARCEL NUMBER: /" /(We will provide this for you)
SUBDIVISION: kl-v, hir-")t 0� ID t'f�i UNIT# BLOCK# LOT#
(Addressing is based on t information - must be accurate)
Dwelling Units:i Parcel Acres: 2
OWNERNAME lJ`U 11, rAeiry / Z. ( CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
APPLICANT (If other than owner).
(Applicant if other than owner, a statement
APPLICANT INF RMATION:
STATE;_ ZIP_
PHONE #: Home (
CONTRACTOR:
to act al agent
Work
owner must accompany this
l.Z(
Cell (
MAILING ADDRESS: CITY STATE ZIP
PHONE #: Home (
EMAIL E
How many buildings are located on this Inc
Did you recently purchase this property?C
Is this a lot splitNO YES (Please brin
PROPOSED USE:
(i.e., Single Family Residence, Multi Family,
Work ( ) Cell (
IDAHO REGISTRATION # & EXP. DATE KLt
(If yes, list previous owner's
of new leoal descrintion of n
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 2003 International Code in
cases of any false sDarrm*lsint or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started 8 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 your check does not clear**