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HomeMy WebLinkAboutAPPLICATION - 06-00230 - 673 Johnson St - New SFRCITY OF RFXB URG '✓ PERMIT # O�BWO0-�2 30 BUILDING PERMIT APPLICATION Please complete the entire Application! 19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable 208-359-3020 X326 PARCEL NUMBER: JZPR 1}N D5a0001-10 ( We will provide this for you) SUBDIVISION: UNIT# BLOCK# vl LOT# 1% (Addressing is based on the information - must be accurate) OWNER NAME: McK+-r/NA LEIsamAtJ CONTACT PHONE# 7/49 - 0Y2Q PROPERTY ADDRESS: t0-�3 Sod,,So/i A-UL PHONE #: Home Work (2z8) 7/(0- DyZp Cell (Zo8) 71to - 04 z_ OWNER MAILING ADDRESS: 4//5 VloLET CITY:)&X8✓g6 STATE: s•O.ZIP:83wo EMAIL Nl/'.i(f /P/ShinaAJb!5)rnarl - c:c ,, FAX 35q- 9791 APPLICANT (If other than owner)_ (Applicant if other than owner, a statement APPLICANT INFORMATION: ADDRESS STATE; ZIP applicant to act as agent for owner must accompany this PHONE #: Home ( ) Work ( CITY: Cell ( MAILING ADDRESS: 9,22 ()16}F AOJE- CITY RE)03d1ZG STATE T. D. ZIP�i Q_ PHONE #: Home 359-i9/oZ Work (.-XO ALf - A' Cell( ) �at,ni✓ EMAIL FAX 30-3.4IDAHO REGISTRATION # & EXP. DATE &BIrfI 14. 01 How many buildings are located on this property? Did you recently purchase this property? No es If yes give owner's name) /i/ICK `I- -Fin/A c..E/S//�9Ao Is this a lot split? ©O YES (Please bring copy of new legal description of property) PROPOSED USE: Sw(.LE FArt)Ly QES _ (i.e., Single Family Residence, Multi Family, Apartments, 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. 1 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 2 03 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or apirovaTwas baAd. Pert,4 void if not started within 180 days. Permit void if work stops for 180 days. DATE Do you prefer to be contacted by fax, email or phone? Circle One WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! Plan fees are non-refundable and are paid in full at the time of application beginning January /. 2005. City of Rexburg's Acceptance of the plan review fee does not constitute plan approval *"Building Permit Fees are due at time of application*" "Building Permits are void if your check does not clear"*