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HomeMy WebLinkAboutALL DOCS - 13-00139 - 581 Caribou St, Rigby - Addition14IN' In T -"a, "'I' 1 m A 17M 01 . . ..... .. i 1 C I I Y o F �J� — Please Complete die Entire Application! REXBURGIf the question does not apply fill in NA for non ipphicable _._...--- fy, ..___ Amernat IOmily Community [AL & MULTI FAMILY BUILDING PERMIT APPLICATION ;XBURG, ID 83440 PARCEL NUMBER: ( We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT#. Addressine is based on the information - must be accurate �OiXNERN"E.- 196Y+10Y9NTAC,JT� P�71� PHONE 44 )09) (76 �i �(y / PROPERTY ADDRESS: CL yI V -S/ ASL IVO hJ 12 PHONE #: Home Work Cell OWNER MAILING ADDRLSS: 6,)V Wi1Pivl ], CITY: e V STATE:i[fiZIP: T5 f/, j0 EMAILnt1pAR APPLICANT (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS CITY: STATE; ZIP EMAIL FAX PHONE #: Home Work Cell MAILING ADDRESS: CI'I•Y SI"ATE ZIP PHONE: Cell#. Work# Fax# EMAIL IDAHO REGISTRATION # & EXP. DATE How many buildings are located on this property? Did you recently purchase this property? td'NO (If yes, list previous owner's name) ❑ YES Is this a lot split? ❑ NO ❑ YES (Please bring copy of new legal description of property) PROPOSED USE: (i.e., Single Family Residence, Nlupi farnily, Apartments, Remodel, Garage, Cotrunereial, Addition, &c.) APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penally of perjury. I herebyeertiry flut I have read this application and state that the information herein is correct and I swe:u that any information which may hereafter be given by me in bearings before the planning a...I Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. 1 agree to comply with all City regulations and State lams relating to the subject matter of this application and hereby authorized mpresentetives of the City to enter upon the above-mentioned property for inspections purposes. NO'fli: 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 apkilication or the plans oan+p�hich [h�n� e perit or approval was based. Perini[ void if not started within 180 days. Permit void if work stops for 180 days. 6 Signature ofOwne' jdpplicant DATE, Do Vol] prefer to be contacted by fax, email or phone? WARNING— BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITEI Plan fees am nan-refundable and arc paid in full at the time of application beginning fatom f 2005 City of Rexburg's Acceptance of the plan review fee does not constitute plan approval 1300139 581 Caribou St, Rigby - Addition 04/17/13 o4g8xeUgc, F; �y. 4 O a) Routing: Done NA ❑ Ted Dye (Please review by Friday, April 19) ❑ Current Status Please complete the following: Done„ NA A��'/ ❑ Review Plans ❑ X Enter Notes in the Checklist under P&Z Review in the Workflow ❑ Enter Notes in the Checklist under Building Review in the Workflow ❑ Update the Result U.-' ❑ Stamp Job Site Copy as Approved V�-❑ Return building plans and this check list to Amanda Saurey Notes: v 0 Number: 13-00139. Status: REVIEW —Select- -R Check amandas 100.00 E 1 wz Found: I 6isPlaYinq. Ito, 1 Xpress Bill Pay - Payment Processing Y ° '` City of Rexburg Quantity 35 North1st EastpnEXp�URG 'Building Permit Deposit Rexburg, ID 83440 mr4•ricd's fi3mitrCamm�unlry 208-359-3020 Page 1 of 1 40 Cal. Printer ► Transaction detail for payment to City of Rexburg. Date: 04/23/2013 -10:21:16 AM Transaction Number: 1999968OPT Mastercard — XXXX-XXXX-XXXX-8916 Status: Successful Account # Item Quantity 1300140 'Building Permit Deposit 1� 1300139 Building Permit Deposit 1 1300140 Building Permit 1 1300139 ;'Building Permit 1 1300140 BP Plan Check Fee �'i 1 1300139 BP Plan Check Fee 1 !. Billing Information Martin Orozco 83442 Item Amount[ E $-100.00 $-100.00 $76.21 $76.21 $32.50 _..._.$32.50 TOTAL. xtended Amount'. $-100.001 $-100.00'1 $76.21 $76.21 1 $32.50'1 $32.501 17.42 Transaction taken by: amanda Payment Service Provided By www.xpressbilipay.com Copyright © Xpress Bill Pay 20133 -All Rights Reserved �......___.____.. https://www.xpressbillpay.com/common/payment_process.php 4/23/2013