HomeMy WebLinkAboutBP & APPLICATION & CHECKLIST - 12-00210 - 1117 Coyote Willow Way - Shed-e-
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RE SIDENTIAL BTNLDING PERMIT35 N 1" E, REXBIJRG,ID 83440
208-372-2326
APPLICATION
LOT#ion - mr:st be accurate)
Parcel Acres:
the Entire Applicadon!
applyfill in NA for non applicable
PARCEL Nuunnn kRRr"lun€ s.:nstt ( we will provide this for you)
SI.]BDIVISION:LINIT#BLOCI#(Addressing is based on
Dwelling Units:
PROPERTY ADDRESS:
PHONE #: Home ( )
ONhIE R MAILING ADDRESS :
APPLICANT (If *!:i:h""
(Applicant if other than owner, ",t"t -.'t@ agent for owner must "fuAPPLICANTINFORMATION ADDRESS CTTY, &trpupgSTATE; tf' Ztp_ZTrffu EWLlss(o*rur.noJ,t.* ghry+,rfAx
PHONE #: Home GII( )ur sC?-Z/q
MAILING ADDRESS
PHONE #: Home (
EMAIL
, P-o,Bar toil crrV_0-sEa4_STATE ,.t ,rn_tJ_lfu
IDAHO REGISTRATION # & E)(P. DATE
APPLICANTS SIGNATIIRE' CERTIFICATION AND AUTIIORIZATIoN: . under penalry.of perjury, I hereby certify tbar I have read hi.application and state that the information heoi" r .o.."., *d r ,*r.th"i r,'yiofor-"uoo *li.l ,i.y'["#rrr., u" given byme in hearings before the3ffiTifrtr"?ffilHnf:,gff.***:flHiyfg'ryil;'h^,r;J;#;:i,s*.i".-fry*i,nl'?.y*g"rdonsand
f"t i*p-..tiooi pirrp-_*J, " Nbre,m. u"Ia;*'5r?il^r mav *,.r." , npmit ^- ":lI::?::'l^T lf- *t Itrt ;*n. ,,pgo.rL aborr.-rn oiionla pt p.q'-rorinspectionsp"'po'e'. :9x*:y,g*_;r"r':r6;;:#i;:ffiffiff*"r:[Tsf.:ffyr:ff*'fiil:?il.T#;:m"n#ffi:.flcases of any false s,'.nrent or misrepresentadoo of fa.. inr-he;;;lt ;,ffi;.'"'*. or^^ on which rh. perioit or approval was based. persrit void if notsaned within 180 da1n. .pennit void if work stop, fo, IAO d"f .'
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JH+aL/ 2onDATEApplicant
Pranreesa,effi:***1i""::g::-r^*-y_ll$"'j-"Fr;il#i:ffi ;"),)i!).roo,Gtyof Rexburg's Acceptance of the plan *"i".r"" a""r'i"?;;;;i;i1!itifffi*nit Fees are due at time of applicationx'*' *oruilding p"rrri"
"*ilifilolrr.n".k does not cleat'rr-
':'"'Building Permit Fees are dui at time"i "ppri."t"ir--- ..t;ildir;*p;;; il?:fr? 3fr1
12 00210
lllT Coyote Wilow Way - Shed
0s/02/2012
Routing:
" H euinton owens (please review by Friday ,May 4)
Please complete the following:
Done NA
,t ! Review plans
"/
n ,
" A r Enter Notes for the applicant under Submiffals
') r/(,t I Update status in the Approvals tab
Notes:
r Return building plan and this check list to Amanda saurey
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No sia.-ol 7[a,-,s yet- -