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Home My WebLink AboutAPPLICATIONS - 06-00294 - 350 Cul De Sac Dr - AdditionCITY OF- RE. XB UR G nUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208-359-3020 X322 PARCEL NUMBER: SUBDIVISION: 0 a �- Please If the quo PERMIT# i%f�:�9q A [TI`TIT# (Addressing is based on the infonu'......... ation , must be accurate} -Lw� 06 00294 350 Cul De Sac -Addition OWNER N"E• AA ,) e.,,,,1", . PROPERTY ADDRESS :_3Sp L vL 1E S A c... CoNTACT' PIION'E # Cell ( ) .,.,�•.....-.�L,��v r�Li,icr,��: gav CUL'p-- C-SAC CITY- STATE:-� EMAIL FAX APPLICANT (If other than owner) (Applicaint if other than owner, a statement authorizing applicant to act as agent for owner wast attainart � this a Iicat' A � application.) APPLICANT INFOR MATfON: ADDRESS CITY: STATE; ZIP EMAIL FAX PHONE#: Home ( ) Work ( Cell ( . CONTRACTOR: MAILING ADDRESS: PHONE.- Home#356-73b2 W 7'� w CITY_„_ CT_�TATE�Yj ZIP ork# Cell# LMAIL FAX 0- Idah Oq How many buildings are located on this property?_ � nllorl you recently purchase this properly? N�� Yes (If yes give owner's name) Is this a Iot split? p�. YES (-Please bring copy of new legal descri flan of F prapCriy} PROPOSED USE: �z (i.e., dingle Family Residence_ M CIE -Lkc.>3l �fW11jouel, uar� Commercial, Addition,, APPLICANT" S RIE., CERTIFICATION N t t tai r f N"* n r penalty f F F app ti and tat th at the i"form at on h r in � perjury. urs , I hereby b certify correct n f w r that any ir�f�� tion which � riahereafter y me Y h ar' before the Planningand Zoning - be �r�ri�r� r � City ��11 for t�� i F of �. b with all Ci r r ul at' a t t � rel tin Rexburg shall b truthful ars correct. I a to comply t t� �� - 1�t� apliat�r� r� hereby upon the above-mentioned for zu tion�authorized d r resentati the i t enter �urP�� ry�; `�1� ��1d�n it �� F r1� � t� � ��trnatir�al in r�.� �t � approval issuedunder t�� yes any l statement. or m - r r nt t "on � � � ns on . }grit r aPP��O�� 1 1��Aa rid iwithin � t �r� t a��i �t� � r t�. �. r It � i f r stops for 180 days. i re at .r of Owner/Applicant Do y0u refer to be contacted b -v fax DATE' emai orPone * Circle One WARNING — BUILDING PERMIT MUST IRE POSTED ON Plan �' �- non-refundable an CONSTRUCTION��°T' � are paid in full t the, tire. f li ti t City of Rexburg's Acceptance of the plan review fee does not constitute uiiYnPermit�'� � n t tip f i �1n approval lfin * uildin Pernik are o- if on hdoenit . '11c lam_ 35b-Sfa53`1 Work rnarnrFu r„A A IT CoNTACT' PIION'E # Cell ( ) .,.,�•.....-.�L,��v r�Li,icr,��: gav CUL'p-- C-SAC CITY- STATE:-� EMAIL FAX APPLICANT (If other than owner) (Applicaint if other than owner, a statement authorizing applicant to act as agent for owner wast attainart � this a Iicat' A � application.) APPLICANT INFOR MATfON: ADDRESS CITY: STATE; ZIP EMAIL FAX PHONE#: Home ( ) Work ( Cell ( . CONTRACTOR: MAILING ADDRESS: PHONE.- Home#356-73b2 W 7'� w CITY_„_ CT_�TATE�Yj ZIP ork# Cell# LMAIL FAX 0- Idah Oq How many buildings are located on this property?_ � nllorl you recently purchase this properly? N�� Yes (If yes give owner's name) Is this a Iot split? p�. YES (-Please bring copy of new legal descri flan of F prapCriy} PROPOSED USE: �z (i.e., dingle Family Residence_ M CIE -Lkc.>3l �fW11jouel, uar� Commercial, Addition,, APPLICANT" S RIE., CERTIFICATION N t t tai r f N"* n r penalty f F F app ti and tat th at the i"form at on h r in � perjury. urs , I hereby b certify correct n f w r that any ir�f�� tion which � riahereafter y me Y h ar' before the Planningand Zoning - be �r�ri�r� r � City ��11 for t�� i F of �. b with all Ci r r ul at' a t t � rel tin Rexburg shall b truthful ars correct. I a to comply t t� �� - 1�t� apliat�r� r� hereby upon the above-mentioned for zu tion�authorized d r resentati the i t enter �urP�� ry�; `�1� ��1d�n it �� F r1� � t� � ��trnatir�al in r�.� �t � approval issuedunder t�� yes any l statement. or m - r r nt t "on � � � ns on . }grit r aPP��O�� 1 1��Aa rid iwithin � t �r� t a��i �t� � r t�. �. r It � i f r stops for 180 days. i re at .r of Owner/Applicant Do y0u refer to be contacted b -v fax DATE' emai orPone * Circle One WARNING — BUILDING PERMIT MUST IRE POSTED ON Plan �' �- non-refundable an CONSTRUCTION��°T' � are paid in full t the, tire. f li ti t City of Rexburg's Acceptance of the plan review fee does not constitute uiiYnPermit�'� � n t tip f i �1n approval lfin * uildin Pernik are o- if on hdoenit 4 F00 R-iease complete the eiture AP,,plication! If the question does not aAuly fill in NA for nnn a.,,,r,..Q hio NAME (�7`� M) PROPERTY ADDRESS SUBDIVISION I. -P � 6,k S �A- (... Dwe.1 I ing Units: ,!� . Parcel Acres: il SETBACKS FRONT SIDE r YV4 `lam SIDE 2.0 BACK S Remodeling Your Building/Home (need Estimate) Pemil*t# SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) 11 I First Floor Area Second floor/10ft area Third floor/loft area Shed, or Bam i N� Unfinished Basement area Finished basement area garage area w .Carport/Deck (30"above grade)Area &M Wader Meter Quantity.�� mater Meter Size-, Required!!! PLUMBING Plumbing Contractor's Name: Address Contact Phone: ( 6e BusIN iness Name: F:F City �Z��_State-,A �„Zip-83Ll`lD Business Phone.( ) Email Fax FIXTURE COUNT (includ in r_ ouzhed_ fixtures Clothes Washing Machine Dishwasher Flour Drain Garbage Disposal Hot Tub/Spa I finks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ (Commercial Only) Sprinklers Tube'Showirs r' l Voile rina1 Water Heater 'Water Softm�r-%�r --------------- Signature of Licensed Contractor License number Date The City of Rexbur�-'s permitfee schedule is the sa,�ae as requ.ir•cd by the State of Idaho v F %wo N �Z— I.... S I. -P � 6,k S �A- (... Dwe.1 I ing Units: ,!� . Parcel Acres: il SETBACKS FRONT SIDE r YV4 `lam SIDE 2.0 BACK S Remodeling Your Building/Home (need Estimate) Pemil*t# SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) 11 I First Floor Area Second floor/10ft area Third floor/loft area Shed, or Bam i N� Unfinished Basement area Finished basement area garage area w .Carport/Deck (30"above grade)Area &M Wader Meter Quantity.�� mater Meter Size-, Required!!! PLUMBING Plumbing Contractor's Name: Address Contact Phone: ( 6e BusIN iness Name: F:F City �Z��_State-,A �„Zip-83Ll`lD Business Phone.( ) Email Fax FIXTURE COUNT (includ in r_ ouzhed_ fixtures Clothes Washing Machine Dishwasher Flour Drain Garbage Disposal Hot Tub/Spa I finks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ (Commercial Only) Sprinklers Tube'Showirs r' l Voile rina1 Water Heater 'Water Softm�r-%�r --------------- Signature of Licensed Contractor License number Date The City of Rexbur�-'s permitfee schedule is the sa,�ae as requ.ir•cd by the State of Idaho I'le'ast compiete the entire A applicable pp]1CailOri � If the question does not apply fill in NA for non NAME PROPERTY ADDRESS SUBDIVISION Permit# f Ruireqed!,f fMECHANICAL Mechanical Contractor's Name: ��;, �.......Business Name: Address C ity Stage Zip Contact Phone-, { ) Business Phone: � } Email Fax Mechanical estimate S (Commercial/Multi Family Qnly) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative has -fired appliance Tn6ne-rator System Boiler Pool .Heater Similar fixtures or Appliances Fuel Gas Pipe Outlets including subbedin or future cutlets Inlei Pressure (Meter Supply) PSI Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Dryer Vents Range Hood Vents Cook Steve Vents Bath Faze Vents other similar vents & ducts: Mechanical Si Zing Calculations must be submitted with Plans & Applicat* Paint of D�l�very must plans,be sbawn on�Q� Signature of Licensed, Contractor License number Date The City of Rexburg J S Perinitfe-e schedide I` w s required by the State of Idaho CITY Of AMEMCA'S FAMILY'-0-kiki L ITY State of Idaho County of Madison 19 - }. ...�. vnow 208-359-3020 x326 Rexburg, Idaho 8340 Fax: 208-359-3024 www.rexbu[g.org cmdev rexbura.ora Affidavit of Legal Interest City Be -Ing first duly sworn upon oath, depose and say: (If Appikant is. also Owner of Record, skip to B) A. That I am the record owner of the property desciribed on the attached, and I grant my pen,nission too 4� -7 Name Address to summit the accompanying application pertaining to that property. B• I agree to indemnify, defend and hold Rexburg pity and its employees harmless from an claim or liability resulting from any dispute as to the statements contained herein or as to the ownershrp of the property which is the subject of the application. Dated this Subscribed and sworn to before me the day and year first above wr1P itten, Notary Public �f Naha Residing at: My commission expires;/74 +J` -- r ■v■mfa■■■■'■'■■■t■ ■ ■a■ ■ ■ ■ ■ ■fW ■■■mr■a!■#r ■ 6 ■ ■rf■■ ■ r I SUBCONTRACTOR LIST Excavation & Earthwork: �[;_. \'.� n, ,�y �� Concrete: Masonxy,4 Roofing: Insulafiom, Drywall: Floor Coverings.. Plumbing: Heating.,0 Electrical: t/V\'- C- '�l -11 \'t- 0 vj- ive el.. 00 a e,au.,', Roof Trusses: pn,� Floor/Ceiling �o�sts: S idinglExteriar Trim: Other: co .0v -st"N - mm - ...- px%k-Av'-' Special Construct*or1 (Manufacturer or Supplier) 4� �':2La 11:�+ \ - g