HomeMy WebLinkAboutAPPLICATION - 21-00183 - 2989 W 4700 S - County Storage BuildingMADISON COUNTY PLANNING & ZONING °
134 E Main Street Suite 208 Rexburg Idaho 83440'
Phone: (208)359-6259 Fax: (208)356-6308 ,
BUILDING PERMIT APPLICATION
SUBMITTALS:
The review process will require up to 10 working days (not including the day the application is submitted). All
information called for on this form shall be required for a complete application and no incomplete application will
begin the review process.
GENERAL INFORMATION
Office i lce Only
Building Permit No:
Issue Date: By:
Proposed Use of Permit: Y,N,aAt 5�o�oac 1a'.na
Surfaces: (shall include the exterior wall measurements of the building)
Residential:
Finished Basement:
Bonus Room Finished:
Closed Shop:
Commercial: 60,X15-0,
Other (specify):
Value: $ 1100 000
PARCEL INFORMATION
Parcel Number: RPO5 N 39 E I H 6 607
Property Address (if applicable):
Garage:
Unfinished Basement:
Bonus Room Unfinished: --
Open Shop/Shed: -- "--
Barn:
City: 9ve-Au,2. State: ZD Zip: g3yK0
't e
MADISON COUNTY PLANNING & ZONING
134 E Main Street Suite 208 Rexburg Idaho 83440
Phone: (208)359-6259 Fax: (208)356-6308
Quarter: Section: Township: 0 5 N Range: 31 E
Are you located in a subdivision? Yes No_)�
If yes, does your subdivision have covenants? Yes (Please provide a copy) No
Subdivision: Lot: Block:
By signing here, you herby certify that your building project does not violate any covenants set by your subdivision.
1 understand that Madison County is not liable for any building project that violates said covenants.
-14A4
Owner Signature Date
Zone: Area of City Impact: IVO
Total Acreage: Are there slopes 15-30%? (40
Are there slopes more than 25%? Are wetlands contained on the Property? No
Does the property contain any streams, rivers or lakes? �0
Are you in a floodplain? IV 0 If yes, which zone? WA
Flood Plain Permit #:
If you desire to build in a flood zone you must obtain a Flood Elevation Certificate and a Flood Plain
Development Permit from the Building Department, have your land surveyed to determine the flood
elevation, and submit the completed certificate, signed by the surveyor. A review process will be
conducted by Madison County's Flood Plain Administrator, to obtain his approval and signature. Once
that process it completed and you have the Flood Plain Administrator's approval, you will be granted a
building permit.
CONTACT INFORMATION
OWNER:
Name: \J R '�nr\te CcL L(-
Address:
CAddress: P.0 %ox 4N
City: _ exp \ State: 'f-0 Zip: 83 KHO
Phone: 09- 390. 9540 k Kc J
Email: LO, . ACalce— — 2 @ va.�\oo. cam
MADISON COUNTY PLANNING & ZONING'°°
134 E Main Street Suite 208 Rexburg Idaho 83440
Phone: (208)359-6259 Fax: (208)356-6308
CONTRACTOR:
Name: JieeA U%'s;oma & XAAA `P, A,
License No.: - 138°1 Exp. Date:
Address: ?,
City: State: Zip: ?3`/°1 a
Phone:
Email: o01'►
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 1 swear that any information which may hereafter be given by
me in hearing before the Madison County Building Department shall be truthful and correct. 1
agree to comply with all County regulations and State laws relating to the subject matter of this
application and hereby authorize representative of Madison County to enter upon the above-
mentioned property for inspection purposes. NOTE: The building official may revoke a permit on
approval issued under the provisions of the 2012 International Codes in case of any false
statements or misrepresentation of fact in the application on which the permit or approval was
based.
4"w �i1iti'3 -Jq Y t
Owner Signature Date
Contractor Signature Date
Building Department Date