HomeMy WebLinkAboutAPPLICATION - 05-00099 - BYUI Snow Building - AdditionCITY OF
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D"LOINC-TPEKMIT APPLICATTUN
19 E MAIN, REXBURG, ID. 83440
208-35 9-3020 X3 26
PARCEL NUMBER:
SUBDIVISION:
OWNERA
PROPERTY A1
d.
PHONE #: Home
OWNER MAILING ADDRESS:
Please cc
If the question
Work
UNIT#
o0099
Snow Building
BLOCK# LOT#
CONTACT PH1111,)NE �ff46/^/ Nli
all
Cell
CITY:STATE: ZIP:
APPLICANT (If other than owner)
(If applicant if other than owner, a statement authorizing applicani to act as agent far owner must accompany
Ac4/ ��� mpany this application.}
MAILING AI]0RESS OF
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F
Hoes
CONTRACTOR:
ST.
iHir; (�/
� Work 401),5 Cell (&6� S9R� z3�o
r
MAILING ADDRESS:
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ONE: Homeg Wt.'11rk#jiLel�
Haw many houses are located an t11 -is propertv?
Did you recently purchase this property ? No
Is this a lot split0
? NO
CITY�joUl.�71ruL STATE (IT ZIP p
Yes (If yes give owner's name
YES (Please bring copy of new legal descripti,on4P of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage_
Commercial, Addition, Etc.}
APPLICANT'S SIGNA.TURE, CERTIFICATION AND AUTHORIZATION -certify that I ha.�ve read this applicatio�� and stag that the infol-mation �aerein is cozrect and Iswear that
penalty of perjury, I hereby
hereafter, be given by me in h+�arings be�'are the planning and Zoning Com�nissioz� or the �1 , council t any informatioYa which may
truthful and cQz-rect. I .gree to corr�p]y v�rT�h ��� City regulations and State laws relating tv t e sub e t matterofoCi�y of Rexburg shall be
hereby authorized representatives of the City to enter upon the above-mentionedproperty� f ��s app�ication and
building official may revo�;e a ermit fln a inspections purposes. NOTE: The
p approval issued under the provisions of tk�e 20Q(} International Cote in cases of any false
statement yr misrepresentation of foci in the application oz� Qn the plans on which the permit o�- approval was based. Permit void if not
started ���ithi� 80 days. Per�i�/oid if work slops for 184 days.
00
gnature 01 Uwner/Applicant
DATE
WARNING — BUILDING PERA41T MUST BE POSTED ON CONSTRUCTION SITE I
Plan fees are non-refundable and are paid in full at the timeapplication b beginning
I,2005.'iance
the plan review fee does HOt constitute plan approval
wilding Permit Fees are due at time of application**
*Building Permits are void if you check
does not lug
2
CITY OF
E X B U�. R. -G,
f ICN -S F&MILY COMMUNITY
State of Idaho
County of Madison
I,
%a I 1W AG411 1 �r E) UA Z -0U)
Rexburg, Idaho 83440
wvvW.r urCLOr
Affidavit of Legal Interest
Name 15
Be -Ing first duly sworn upon. oath, depose and say:
Address
State
Noone: 208-359-3020 x325
Fax: 208-359-3024
c o rn d e va, rex bur .or
(If Applicantis also Owner of Record, skip to B)
A. That I am the record owner of the property described on the attached, and I grant my
V *
permission to:
Name Address
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg Gty andits employees harmless from an
claim or liabifity resulting from any dispute as to the statements contained herin or as to �
the ownership of the property which is the subject of the applicaiion.
Dated this day of 20
Si;nature
Subscribed and sworn to before me the day and year first abase written.
Notary Public of Idaho
Residing at:
MY COMMOSSO
ion Aires:
9
Please cola Plete the elittre Annil',pai; v
NAME
PROPER
SUBDIV
ISION
11
If the question does not apply fill in NA for non -applicable
x/a je,; .00000
10
Permit#
Dwelling Units. Parcel Acres:
SETBACKS
FRONT SIDS; SIDE .... BACK
Front Footag (if applicable)
Storm Wader Length
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the
75 746 4001 T"lan! building)
�Floor Area 3(9 .3YL', Ste' Unfinished Basement area
Second floor/loft area finished basement area
Third floor/loft area Garage area
Shed or Barn
Carport/Deck (30" above grade)Area
remodel (Nee d- F-stimated $
Water Meter Count: mater Meter Size:
PLUMBING
Plumbing Contraetor's Name; Bus'
Address ness Dame: Contact Phone: -,—State zip ----
Business Phone: ( }
FIXTURE COUNT (itcluding roughed fixtures)
Clothes Washing Machine
Dishwaslier
Floor Drain
Garbage Disposal
Hod Tub/Spa
Sinks
(Lavatories.., kitchens, bar, mop)
Plumbing EstimateIj $ 11) (Commercial Only)
Sprinklers
Tub/Showers
Toilet/Urianal
1 Nater Neater
Water S . .....laer
Signature of Licensed Contrac_t�or License number Date
T17e City qf Rexbuiws permitfee schedule I's the saine as requiredby�� State of Idaho
4
Please Colllp]ete the en� e App"11ication!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION Permit#
Mechanical Contractor's, Name:
Address Business Name:
Contact Phone,-BusState Zip�iness Phone: � )
Mechanical Estimate � 1'i �� (CommereiaUMulti Familyonly)
FIXTURES & APPLIANCES COUNT
Furnace
Furnace/Air----------- Conditioner combo
Heat Pump
Air Conditioner
Evaporative Cooker
Unit Heater
Space Heater
Decorative gas -CW
fared appliance
Incinerator System
Boiler
Pool Heater
(Singe Family Dwelling Only)
Exhaust or Vent Ducts
Similar fixtures or Appliances
Fuel Gas Pipe Outlets includiYlg S
tubbed in or fia.... e outlets
Inlet Pressure Meter Supply) PSI
Heat (C]".rcle all that apply has Oil Coal Fireplace Electric
Dryer -Vents
Range Hood Vents
Cook Stave Vents
Bath Fan Vents
other sixnila N11.7 & ducts:
Mechanical Sizing Caleuiat*aons must be submitted with Plans & Appfication
Faint of Delivery must be shown on plans.,
Signature of Licensed Contractor
L-wense number
The City bu 'sperm schedule. i ham �� r
ui!f____aho
5
CITY OF
NEI
f EX B U P�6,G
AN1E�.�ICKS FAMILY COMMUNITY
I U L- IVICIII I %3L.
Rexburg, Idaho 83440
www.rexburg.org
APPLICATION; "CONSTRUCTION PERMIT "
Phone: 248-359-3020 x326
Fix: 24$-359-3024
cdd a�rexburg.org
CONSTRUCTION PERMIT #:
PERMIT APPROVED,; YES/ NO $50.00 FEE PAID:
APPROVED BY:
-APPLICANT INFORMATION:
BUSINESS NAME:
OFFICE ADDRESS:
City State Zip
OFFICE PHONE NUMBERS ( �
CONTACT PERSON: CELL PHONE # ( )
-LOCATION OF WORK TO BE DONE:
mm0
STREET ADDRESS WHERE WORKm'WILL BE DONEE
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:
D AUTOMATIC FIRE -EXTINGUISHING SYSTEMS
El COMPRESSED GASES
❑ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT
F1 FIRE PUMPS AND RELATED EQUIPMENT
❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS
1:1 HAZARDOUS MATERIALS
Ll INDUSTRIAL OVENS
FJ LP -GAS
i 7 PRIVATE FIRE HYDRANTS
❑ SPRAYING OR DIPPING
El STANDPIPE SYSTEMS
u TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES
APPLICANTS SIGNATURE
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YES/NO
2
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Loafing:
} v 1 .{-ti, 4� . _-- -
Drywall,0
Painting:
Floor
Coverings.,
Plumbing:
Heating:
Electrical:
Special Construct*on
Manufacturer or Supplier)
Roof Trusses:
Floor/CeHing kists.-
Siding/Exterior Trim:
Other:
7