HomeMy WebLinkAboutAPPLICATION - 06-00223 - Tew By 4 ApartmentsCITY OF R-EXB UR G
BtALDING PERMIT APPLICATION
14 E MAIN, REXBURG, ID. 83440
208-359-'.')"020 X326
PARCEL NUMBER.�{L�f
SUBDIVISION:_,y�[�„ f
(Addressi sed on the infor
OWNER NAME: .... 47
PROPERTY ADDRESS.
Please ca
If the questi(
tTNIT#
ation - must be accurate)
PHONE#-. Home ( ) Work
OWNER MAILING ADDRESSIL5? qoos
EMAIL
Fax 86 (• ;25*5 1;?s
PFR MTT !!
0600223
Tew by 4 Apartments
CONTACT PHONE #�C�/• Qo2�5'— 3eoz-S
CITY:
Cell ( )
D reth STATEjq_ZIP: 8
APPLICANT: (If ether than owner)!qA
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESSff5_1 1? kil II CITY: All�,��u,.
ST1�►.`IE; ZIP ;$5 Yy EMA I L FAX
PHONE #: Home (WiScr Work Cell � )
CONTRACTOR: �
MAILING ADDRESS:
.0d
5M117_ <�r (9F _IIIIZ,
Q3
eS' CITY . STATE_Lo 7IP 3 z
PHONE: Home# Work# Cell#
EMAILtino-u,t.��6e� _ � FAX 3S� • $ ! y' Z IDAHO REGISTRATION#�� ' � � l3
How many buildings are located an this property? III
D id you recently purchase this property.Nc Yes (If yes give owner's name)
Is this a dot split� YES (Please bring copy of new legal description of property)
PROPOSED USE. � u ITel --I
&ce
(i.e., Single Family Residence, Multi .Family, ApartrV
rets, Remodel, Garage, Comm erciaAddi,,tion
Etc.)
APPLICANT" S SIGNATURE, CERTIFICATION AND AUTHORIZATION.}
venalty ofperjury,,, here y ceril that I
have, read this application and state that the information herein is correct and I sear that any ink`
.�1nrYin�n� tlir� rntrriin �' the i out�il or the i
.iyi �� 11� rrr�:
1.exbur, shall be true and correct. I agree to complywith X11 �i regulations
rain t the subject attrfti application hereby ` t regulations and State laws
p ' authorized representatives sent tives f to City t enter upon the above -mentione r for ins
T'E. The building oiaI arevokeMerit on approval ist��. under �. provisions property �'` �t1c�n� purposes -
NOTE: ��" the Ir�trn�t����1 '�� ��� eti��e� of any false statement or
Y s rep res entti on of fat in the ap p I j cat i on or on the p i ares on wh 1 ch. the��! t r - �-� .1 �
stops for Y . .
� p �a has e d. Pe mi it voidi�' �.t strtd thir� 1 d ays_ I�'�,rriit c�r� f����r
Signaftff 0r Y
ppli nt
Do you prefer contactedPby fax, f'Circle
WARNING — BUILDING PE , NST
Plan fees are non-refundable and are paid in full at the time of application
City of bur 's Acceptance of the plan review fee does not cans Ii
u
"Building Permit Fees are due at time f application" "Builth
ng Permits are voi,
rn 'ITE!
unLt 1 000.
if
iTapprov the l does not clear**
CITY OF REXE'URG
M%0M, : Rey E Taw
aft
FAX NOr 125 pr.
3565770 FUTURES OF I • ,HQ
9
State of Idaho
County of Madison
T Ir 4) 11
)R.G
............
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7
29 2006 0-("':07AM P1
PAGE 03/06
BUILDING SAFETY DEPARTMENT
Mw"
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WARM
Mdav%lt of LegalInterest
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ulty
BeitW first ditly, -K
-sworn. upon ostLh, 4CV05C jind:say
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A,darm
11
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44
(Ii' APPIic�« iva ileo DwtieP off" Rtvoni19 skiff W n) �A) I"" /. �v'��:7 /4- i�G'tr-1 CIV -4-iiiJ
A. That 1 .4M the record numvl of the "t",%^Awr Aa.,,..:�,ma ,,...�.,, ,...,._,._� __ a T ___..____
v "
Pam, ission to:
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I
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4p'i t7,[Ic�'
�� C'!J/J'�1'Li4-t �'Ul4 `i Addrovs _ _
to -submit the accompanying appli.cation pezWningto that pmpertyKIG�X O U,¢L7 g w�?-44 0
r
Dated this
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SAL -91 M I I 1p 19
day of
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Substn'Lbled and ora. to bidom me the day and ycax -first zqbo^ittcn,
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My wMMISSIon exrMM-�,�G'�,J�'7�
Application!
Please complete the
If the question -does not apply fill in NA for non applicable
Imm"',
r�aME I cu.
PROPERTY ADD
M-0
SUBDIVISION J
--- AN IV I
I
Dwelling Units: Parcel Acres:
SETBACKS
FRONTo� SIDF,__���SIDE
map]
Remodeling Your Burlding/Home (need Estimate') $
40t
Permit#
BACK Q I
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area
Second floor/loft area
Third floor/loft area
Shed or Barn
d -v
Unfinished Basement area X
Finished basement area
Garage area
CarpartlD_eck (30" above grade}Aria
Water Meter Quantity,-Size:I Water Meter
Required!!!
PLUMBING
Plumbing Contractor's Name:
Address .:7 14,�r ��
Contact Phone: ��� )
Email
FIXTURE COUNT (includin,
k��
roughed fixturEs
Clothes Washing Machine It
y Dishwasher
� ►E Floor Drain
Garbage Disposal�vl
- Hot Tub/Spa
_-- Sinks
(Lavatories, kitchens, bar, mop)
Business Name:
-a.
City State Lip
.Business Phone: ( )
Fax
Plumbing Estimate $A,-Ia 00 (Commercial Only)
AWr __ff -opff I
�'"� Sprinklers d
�/ r� Tub/Showers
1 `� Toilet/Urinal
cater Heater
ager Softener
[gnature off_A(Viised Contractor fi �ce n�s e�n uX b�e r It
7
ply cy R ev p erm it uelv s cn eaui e> is " A
L in -e same as required vy the State of1daho
!I
Please complete the entl Appli'cati'01116 Ifthequestiondoek lapplyfillinNAfornon
applicable
NAME _ T
e,,0 y U
PROPERTY ADDRESS
SUBDIVISION AV
Required!!!
Mechanical Contractor's Name:
Address '� 1'.
1. L-
contact Phone:
Email
/,W.
Penuit#
Business Name:
a
_City Stade ' Zip
Business Phone: ( }
Fax
Mechanical Estimate $ � c�af>-Wlm �CommereiallNiulti Family only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
_,,�2 -Air Condit -loner Space Heater
Bath Fan VentsUnIt Heater
Range Hood Vents
Boiler
Cook Stove Vents
.� Decorative Gas Fireplaces
� Y .Dryer Vents
,,k` Evaporati've Cooler
Exhaust or vent duets �-y,O
Fuel (gas) piling fixtures or appliance outlets
Furnace
Furnace/Air Conditioner combo
4� Heat Pump
Incinerator
Pooh Heater
Heat (Circle all that apply)
Gas Oil Coal Fireplace Electric ��(�0" `G
t
IV
Mechanical Sizing Calculations must be submitted with Plans & Application
--� �oint of Delivery must be shown on plans.
Situne of Licens o actor icense n tuber
Required!
Date
The City of ' ut�g'sperm itftv schedule ' the same as required by the St
ate? of [daho
5
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Cl T
ia
EXBUR.BuILDING S
..G.
oA
19 E. Main St.
Phone: -359-3020 x326
Rexburg, Idaho 83440 Fax208-359-3024
www,rexbu janellhgrexbur
APPLICATION: " CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED*. YES/ NO $50.00 FEE PAID: YES/NO
APPROVED BYI.
-
•APPLICANT INFORMATION:
BUSINESS NAME:
OFFICE ADDRESS:
City State Zip
OFFICE PHONE NUMBER: ( )
CONTACT PERSON: CELL PHONE # ( )
-LOCATION OF WORK TO BE DONE:
STREET ADDRESS WHERE WORK WILL BE DONE:
BUSINESS NAME WHERE WORK WILL BE DONE:
DATES FOR WORK TO BE DONE: TO
CONTACT PERSON:
PHONE NUMBER: ( ) CELL # ( )
PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR;
❑ AUTOMATIC FIRE -EXTINGUISHING SYSTEMS
❑ COMPRESSED GASES
FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT
❑ FIRE PUMPS AND RELATED EQUIPMENT
FLAMMABLE AND COMMBUSTIBLE LIQUIDS
r.1 HAZARDOUS MATERIALS
j, -
INDUSTRIAL OVENS
El LPoGAS
1:1 PRIVATE FIRE HYDRANTS
El SPRAYING,OR DIPPING
�`� STANDPIPE SYSTEMS
u
TPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES
rl
APIYILICANTS
BE MAMBOO■■ A■ MIMMIN■ ■■ on aMAN a M O! N K E N N ■ N ■MIR 10 0 2 i■■ w s 0 Ron SOMME no!n OREN0AEmma ROMEN NON ■ Room 0NINE a BERN 1
71
Excavation & Earthwork:
Concrete:
Masonry -
Roofing.0
0 CF.,
Lr S s -c OF
Insulation: � �
Drywall.- .54 C
Painiing:
Floor
Coverings:
Plumbing:
Heating:
Elecirical:
Roof Trusses:
Floor/Ceiling Joists; � �� c�c_
SidinglExterior Trim:
Other:
1,(001 � z
SUBCONTRACTOR LIST
Special Construction
(1Vlanufacturer or Supplier)
7