HomeMy WebLinkAboutAPPLICATION - 00-00018 - Ashton Memorial Hospital - AdditionDate of Aj)pjjCativn��
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CITY QF REXBL-,R(;, IDAHO
APPLICATIQN FOR BUILDING PERMIT,
No.
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West will EtrucVUrc; be used for (inclua
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Total Est1wMated cast- Will dweding be -in a flood plain?
Signature
applicant
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-Buflaing
FOR 'ICE USS ONLy
Building Pe -mit Fe%'.*�'E
Plun-abing Pe--rn it FeeZEAM C<)
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Date of Application,
Job Address;
99
CITY OF REXBURG / MADISON
MANUFACTURED HOUSING / MOB
APPLICATION FOR BUILDING
LEGAL DESCRIPTION
Lot No.Bock:
OWNS
Name- %7
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COUNTY
I LE HOME
PERMIT
Permit No.
ATTACH COPS IF NECESSARY
Subd ' n/Mo i l Home Park
Street Address* z %0,��,�
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P: S-3 416 /
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Tel, 73CO2-01
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Zip: Tel
PROJECTINFORMATION
Name*
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City, State:
i# Tel
Ida. Lic.
BUILDING CONCRETE CONTRACTOR
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Year Mfg1d:
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STRUCTURE;l l . Repair:
Foundation:- Garage:
---Awning,
Other;
SQUARE FOOTAGE* House*
Garage, Other:
EST& COST: House-, Garage: Found at ion
SITE ENING CLASSIFICATION:
TAX CODE
Well Permit (County Onl
y):
Building Permit Fees
Plumbing Permit Fees
Water & Sewer Hookup Fees*
Signature of Applicant*
Signature Builda.ng Inspector:___
Issued
BUILDINGTYPE
Septic Tank Permit County Only
Plan Check Fees
Digging Permit Fees:
Other Fees*
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CITY OF REXBU .31
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APPLICATION FOR PLUMBING PERMIT
OWNER
FEES
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Name L��
Address,
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Lot 131k,
Addt
Name
Address
Tei.
NATURE [)F INSTALLgT1ON
Use
Plumbing
Rough Plum
o -n N, n q
Septic Tank
Fixtures
Complete
DESCRIPTION OF
Bath Tubs
Showers
La u n, d ry Trays
Wash Basin
SJOP Sinks
Kitchen in
Floor Drain
Dramn9Fountains
Water Softeners
D I
ish Washing Mach.
Clothes Washer
1fumbing Permit ■■
'P 6 v a $
Sewer Inspection
Inspection C)f Pjpe
Inspection of Fixtures q IL It $
0 1r;;J,,: 7,
Received- Date
Hough P�Limbjnq
Sevver
Other
Finish Plumbin-a
TOTAL
INSPECTOR'S RECORD
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Jul 'P-20 /U
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CITY OF REXIBURG ,,ADDRESS FORM
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