The URL can be used to link to this page

Home My WebLink AboutAPPLICATION - 06-00081 - Beehive Inc - SignCITY OFREXB UP G BUILDING PERMIT APPLICATION - 19 E MAIN, R�XBURG,1D. 83440 208-359-3020 X322 PARCEL NUMBER: SUBDIVISION, rf, • • i (Addressing is based on the information - m Please If the ques OWNERNAM�E�: PROPERTY ADDRESS:, M V k,o 00081 .6,24 Centennial Loop ,,Basement Finish UNIT#- BLQCAI4 LOT#� ist be accurate) �' � Jac L', CONTACT PHONE L PHONE #: Home (�� !�1 CxWork s�� k_,ell (22� OWNER MAILING ADDRESS: Cps'. EMAIL ��ITY'--�STATE:�ZIP:�3i/�� j _ �� c o � �a 1�r� r cs AX APPLICANT (If other than I ------------ owner)(APPlicant if other than owner, a statement author -z -n APPLICANT INFORMATIflI`rT: I I g applicant to act as agent for owner must accompany this application.) DDR -ESS CITY: STATE.: I —ZIP EMAIL FAX PHONE #..- Home Work Cell( CONTRACTOg: MAILING ADDRESS: CITY PHONE--, Home# I -L-4 Wo,X%l SII4- EMAIL —FAX Ic How many buildiongs are located on this property? Did you recently purchase this property, Yes (1f yes give owners name IS MIS a lotlit? A T YES * NO ' (Please bring copy of new legal descript" n of prop 10 PROPOSED USE: .i 10 lk 9 Il=ns i. (I e., Single Family Residence Mlu� ti Fanffly, Aparftn B 1 7 ents, Remodel, Garage, Comrnercjal� Addition APPLICANTE'S SIGNATURE, CERTIFICATION AND AUTHORIZATIO - i d that I have read this applicat- No n )16 artPe CL odb�-QT-p UTY= ion and state that the I ere y ce fy nfon-nation herein is correct and I swear that any iTiforination wh'ich mav herea n hearings before the Planning and zoning Comm'ss, fter be 9'ven by me with ail City regulat,,ms and State laws relat' I Ion or the C"ty Council for the City of Rexburg shall be truthful and correct. I agree to c-ornply ina to the bject matter of thips appficat' hereby authorized representatives of the City to enter upon the above-mentioned propefty for in -s u ion and spections purposes. NOTE: The building official may revoke a permit oii approval issued under the provisions of the 2000 Intemational. Code in cases of any false statement or misrepre permit or approvai was based, Permit v i sentation of fact iti the application or on the, plans on which the o'd if not started within 180 days. Permit void 'f work stops dor 180 days. 6a Signature of 6W rier/A Jic Do. you prefer to be contacted bv fgy pm-q;l nDATE fuie une WARNING - ]BUILDING PEag "ST BE POSTED lar ON CONSTRUCTION SITE I Pfees are non-refundable and are paid in full at the time of application beginning Janugm], 1 2005. Oty of Rexburg":s Acceptance of the plan review fee does nOtcOnstitute plan approval "BuildiPermit Feare due at ti ng es me of applIcation" "BuRdin I g Permits arevoid if You cheek does not clear" STATE ZIP '. 0& CITY OF �EXBUF�,,G AMERICAS FAMILY OMU ITY State of Idaho County of Madison I, Name iW �.. �.��, � J%J) Fnone' 208-3Idaho 83440 www59-3020 rex b u rq . r Fax: 208-359-3024 -- _com _ Ccb- rexburn-nrn Affidavit of Legal Interest Address State Being first duly sworn upon oath, d e -pose and say: (If Applicant is also Owner of Retard, skip to B) A. That I am the record ovAmer of the property described on the attached, and I grant my 0 permission to: Naive Address to submit the accompanying application pertaining to that property. B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from an claim or liability �e��j��Y�g from any dispute as to the statements contained herein or as to the ownership of the property which is the subject of the application. Dated this day of ZQ Signature Subscribed and sworn to befoxe me the day and year first above written. Notary Pubic of Idaho Residingt MY comi ion expires: 'ss Please complete the entire AP,plication! NAME PROPERTY ADDRE SUBDIVISION Dwelling Units: �f the question does nLIX j 0-, -od apply fill in NA for non applicable SS i '*A SETBACKS FRONT SIDE Unfinished p : SIDE BACK First Floor Area Second floor/loft area Third floor/loft area Shed or Baran Water Meter Quantity: Permft4 Plumbing Contractor's Name* Basement area Finished basement area Remode"lng Your BuildinglHome (need Estimate) SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) Garage area Carport/Deck (-'30-"above grade)Area Water Meter Size., Required!!! PL U-MBING Address Contact Phone- al, l Loo Business Name:, City Business Phone.- State 4.1�) Zip Email Fax FIXTURE C OUNT (includin rau�hed fixtures Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Plumbing Estimate $ (Commercial only) Si",gnature of Licensed Contractor Lkense nurnber Date Th,e City ofRexburg'sperinilfee schedule is the same as requ' ed by the (�Iate o Idaho ir Sprinklers Tub/Showers Toilet/Uriffinal Water Heater Water Softener J Sinks (Lavatonmes, kitchens, bar., mop) The City of Rexburg'.s perrnit fee schedule is the sa3ne as required bv the State of Mahn Parcel Acres s EXEMPTIONS FROM STATE REGISTRATION As of January 1, 200611 the City of Rexburg can no longer sell permits without having a copyof your stat registration number or your exemption from the State registraiion. Please send 3 copy of your state e registration or fill out this farm showing your exemption and send it with your license renewal or your next permit application. (This dist is a summarization of Idaho Code Tine 54 Chapter 52D5, far full definitions of these exem dons please see the State's website at www.ibol.idaho. avfcont,htm) � Currently State licensed pursuant to Title 54 Idaho Code, Chapters: 3 Architects, 10 Electrical Contractors/Joumeyman, 12 Engineers/Surveyors, 19 Public Works Contractors (exempt from fee only registration required), 26 Plumbing/Plumbers,, 45 Public Works Construction Management Licensing Act (exempt from fee only registration rpkn�iirnr�i .tr 50, Installation of heating, ventilation and air conditioning systems D Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable activity with na wages or salary D Employee of a US Government agency (State, City, County, or other municipality) 1:1 Public Utility doing construct -ion, maintenance, ar de�elopmeni to ids own business 0 Involved with gas, oil or mineraloperations Supplier doing no installation or fabricating El 0 2 Contracting a project or projects with a total cost less t han $2000 Code Operatio"n of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Any type of water district operations Work in rural districts for fire prevention purposes Owner who performs work on own property or contracts with a registered contractor to do work as long as the property is not for resale within 12 months Owner or lessee of commercial pro on that property perty performing maintenance, repair, alteration or construction ❑ 0 Real estate licensee/property manager acting w�h2n Idaho CQd� Ll Engaging in the logging industry Renter working on the properly where they live With the property owners approval 1:1 Construction of a building used for industrial chemical processing per Idaho Code 0 Construction of a modular building (defined by Idaho Code) to be moved out of state I hereby certify that the above information is tree and correct to the best of my knowledge. Signature Print Name Date SUBCONTRACTOR LIST Excavation & Earthwork.- Concrete: Masonry: Roofing: Insulation: Drywall., Painting: Floor Coverings: Plumbing: Heating; Electrical:. Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists.0 Siding/Exterior Frim: Other: