HomeMy WebLinkAboutAPPLICATION - 07-00330 - 4379 W 6800 S - New SFR Mechanicality Of'Rexb�a�g/ Maaison Counly
BUILD NiG PERMIT APPLICATION
� 0700330
19 E MAIN, REXBURG:, Ii). 83444 � � � i�
208-359-3020 X32"? 4379 W 6800 S
PARCEL NUMBER;
SUBDIVISION: iJNIT# BIOCK-ff—
(Addressingis
based on thel'nformafi'on - must be accurate)
11
PROPERTY ADDRESS:
CONiTACT PHONE
-Ricks
re-3vLvr, �t: t�am� l ) Work i ) Cell ( )
l OVINER MAILING ADDRESS: CITY: STATEk.46
EN1f1IL FAX
A EPLICANT: (If other than owner)....
(Applicant if other than owner, a statement authvnzing applicant to act as agent for ow. ner'm'u-'-
s# accomi)anv this annlicl'tinn I
APPLICANT INFORMATION: ADDRE&E
CITY:
STATE; 10 ZIP 39+4C7 EfvWLzC9l M5 , cc». FAX
PHONE #: Home3S�14 L 4,; Work(�_�� Cell
ICONMACTORIO---
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# CC11#
'EMAIL FAX
How many buildings are located on this pToperty?--,.--
Did
you recently purchaseth's property.? N "Yes (If yes give ownefps nine
Is 'Es a lit spi-r?kL!J0 YES (Please bring campy of new legal descriptian of ��v���)
PROPOSED USE,: Qihnlre A
Ge,, Single Family Residence, N
hi Family, Apartments,Re-model
APPLICANT'S SIGNATURE3
AN UTriFJZA-1'1%--0rAW&•
Under
h eve -read t -" l c� : n . b that Information . r i i penalty� ' perjury, , � hereby �� � � that i
Planning and I swear that any which hereafter h }
I Commis*o r ft City l for the Cidre lat2w ng to the subject matter of th 4 appi a I* y �coffect � �� before
issuedI agree to comply w*th all City regulations and State laivs.
icattion and hereby
r o City o enter upon theabove-mentioned pro for inspections
pu-undcr the rposes.
NOTE: The building official may revoke a permft -o-1 approvalmisrepresen i d on of fact 'in the Opp] a or on the P I W S on Wh ich the permit or r
in cases of any false statement or
s-Dr 1 dads- � id not ed withini ISO days. Permit void if work
. i
eopwil
0Z
y
Signature of owner/Ann1iraw
DA P
uu yuia prorerto ne cnt techdjyail or pholl
WARNING —
-1 zv Ulm Lul IP12 n fees 2re n M -refu nda We a nd 2 re pa 1.0d i n full 2t th e t M. e of a PpReation be -gin a 3 ng Janum. It 1-0�05,2
ACTION SITE I
City of RexbuTg'sreview fee cjeea. not constitute plan approval,
2
}
4
H
W
APPLICANT'S SIGNATURE3
AN UTriFJZA-1'1%--0rAW&•
Under
h eve -read t -" l c� : n . b that Information . r i i penalty� ' perjury, , � hereby �� � � that i
Planning and I swear that any which hereafter h }
I Commis*o r ft City l for the Cidre lat2w ng to the subject matter of th 4 appi a I* y �coffect � �� before
issuedI agree to comply w*th all City regulations and State laivs.
icattion and hereby
r o City o enter upon theabove-mentioned pro for inspections
pu-undcr the rposes.
NOTE: The building official may revoke a permft -o-1 approvalmisrepresen i d on of fact 'in the Opp] a or on the P I W S on Wh ich the permit or r
in cases of any false statement or
s-Dr 1 dads- � id not ed withini ISO days. Permit void if work
. i
eopwil
0Z
y
Signature of owner/Ann1iraw
DA P
uu yuia prorerto ne cnt techdjyail or pholl
WARNING —
-1 zv Ulm Lul IP12 n fees 2re n M -refu nda We a nd 2 re pa 1.0d i n full 2t th e t M. e of a PpReation be -gin a 3 ng Janum. It 1-0�05,2
ACTION SITE I
City of RexbuTg'sreview fee cjeea. not constitute plan approval,
2