HomeMy WebLinkAboutAPPLICATION - 08-00118 - 662/674 Tanglewood Dr - New SFRCITY OF BEXB URG PI
BUILDING PERMIT APPLICATION Please col 08 001 18
19 E MAIN, REXBURG, ID. 83440 If the questiot 66-1/674 'i't111(=0eWO0a
208-359-3020 X326 Dr-TD�i
PARCEL NUMBER: V—pVnSyN E21 T l (We will provide this for you)
SUBDIVISION: S'1onebrid9't_ UNIT# BLOCK# LOT# )K
(Addressing is based on the information'- must be accurate)
OWNER NAME e U t' G CONTACT PHONE # :_1q0 -,Q`230
PROPERTY ADDRESS: U�
PHONE #: Home W20 &SCe-0-D"I Work (Ro$' 3q0 -0A30 Cell
OWNER MAILING ADDRESS: PQ &4 9 3 Z CITY:_D STATE:ZIP: 9—?c1YO
EMAIL CO uta b 'f 4r -90 FAX .3S?_31SZ
APPLICANT (If other than owner) So vn e -
(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 (
CONTRACTOR:
Work (
Cell (
MAILING ADDRESS: PO O c y '93.Z CITY 2 %bl,.r I STATE -�- b ZIP Sf 3tivo
PHONE#:Ho�me (2oe &S(y_aS/Work (aeyr 39,0—D2317 Cell(;)v) 5&9-l3too
$cadtytJui l/6y'T1�G• caavt
EMAIL FAX 359-3/�2 IDAHO REGISTRATION # &EXP. DATE_J(_
How man, buildin¢s are located on this property?.
Did you recently purchase this property? No QLesJIf yes give owner's name) S +V%3bf i dN e i.L r
Is this a lot splitNO YES (Please bring copy of new legal description of property)
I
PROPOSED USE:
(i.e., Single Family Residence, J u u Family,
Remodel, 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 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. Pempt void if noj startedAthin 180 days. JArmit void if work stops for 180 days.
Signature of Owner/Applin LeD.1,f�E U U D
Do you prefer to be entacted by fax, email or phone? Circle One
WARNING— BUILDING PERMIT MUST BE POSTED ON CONST ON SITE!
Plan fees are non-refundable and are paid in full at the time of application be n n ZOO 2000
City of Rexburg's Acceptance of the plan review fee does not constit a pla approval O
**Building Permit Fees are due at time of application** **Building Permits are voi if yo check does not clear**
CITY OF REXBURG
FROM
4/0!/$014 06.14 FAX
FAX NO. :2087854905
TKTT
Please complete the entire Application!
Jan. 18 2008 08:51AM P1
NAME -- �GJe
PROPERTY ADDRVSS 2 Pcrmtr#
SuBDrvIStON—
Dwelling Unite:Puce, Acrer:. �`5� 11 310 St r+
SETBACKS I i� 1
FRONTO SIDt/E IDF`�BACK °W`L
Remodeling Your Building/Home (need Estimate) $_
First Floor Area,_
Second floor/lofr
Third floor/lott a
Shed or Barn_
(Shall inckide the c:teriot wall mea,taranenta of the budding
Unfinished Basement stet
Finished basement area -
G± gc arca
Cmport/Deck (30" above
Water Meter QuanritY: _ .=r.r+.a.t.r .vWaoeeMeceeSize:
Requited!!!
PE UMRING
PIWnbing Conemcmr's Nau,.
Conmet Phone: (ZZ)--j}ih
7d jXg"
Clothes Washing Machirle
_ Dishwasher
_ Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks (Lavatories, kitchen,, bsr, mop)
lusiness Pbone• ( )
F'1 C2—b) !tel ✓
a
Sprinklers
Tub/Showers
Toilet/UrimI
Waret Heater
n
IL_
_Water Softener
Plumbing 8'arirnate $ (COMMk RCIAL/MULTI-FAMILY ONLY)
cr1-7tcv ' A( __�l jog
s4j arr�e of . ensed Mx qr Lica N�
unB E.rp+tancn pye Dom
Th,
it 43r rmrr, r
e002iooi
El
W,r w -
Please complete the entire Application!
NAME 7—hC be:Ue.(01�)Met4_ (nrou.Q cc.C-
PROPERTY ADDRESS 6 n c yz Permit#
SUBDIVISION S�sv�ebNsduc_
Regi redLU MECHANICAL �j
Mechanical Contractor's Name / y Business Name (/ S
Address City / 6!45 state V Zip��`G
Cell Phone 6308� 3/3 ow b Business Phone R),
Fax ( pof is'? --O 62y Email 6� y4.�4 77a iL� / ' «_�
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace
Fumace/Aix Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Exhaust or Vent Ducts
Dryer Vents
Range Hood Vents
Cook Stove Vents
—Bath Fan Vents
other similar vents & ducts:
5 Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that appLyro Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Signature of Licensed Contactor License number Date
The City ojRexburg''s permit fee schedule is the same as reguared by the State
............................................................•.............................1
SUBCONTRACTOR LIST
Excavation & Earthwork: Ku-L&e r Coal f r Lm 4i'O l�
Concrete: &--mcj� CU�LCfe
0
Insulation: Aleco A e— ✓
Drywall: �1cohS &J t,J0 �(
Floor C r _
Coverings: J'w Oxs(f a7pl-fere tr-5
pinmhina- 'L I(�%k`OM KC P ILA M6t "
Heating: LJ TTe 0. 4,1-
n ��—/✓
Electrical: e (5 ,v"` �� 15 l'e c f I C
Roof Trus
Floor/Ceiling]
Siding/Exterior T
Special Construction
(Manufacturer or Supplier)
o u I dp,^� St.110
C (L I( ---j l (
S "o