HomeMy WebLinkAboutAPPLICATION - 95-00024 - Tools for Learning - RemodelAPPLICATION FOR BUILDING PERMIT
CITY OF REXBURG, IDAHO
Date o Applicll,ation
Permit
DYYlYl'el'L r
� z Ck KQASer-N
Name ! tom] I .S C � rC'1 I' Yk 1 YI
A
Street Address j,( F
Mailing Address
City, State��
-V ,
CONTRACTOR
Name
Street Address
Mailing Addres
city
P 21 ►. .. +
Telephone
P
Mobile
Architect. or Engineering Firm
Telephone
Ida. Li.
LEGAL DESCRIPTION (ATTACH COPY IF NECESSARY
Lot No. BlockSubdivision
Job Address
Project -information To be completed by applicant)
Residence Comma Educational Gov ' t
Fence
Structure:
Religious
Patio
Carport
Garage
Awning
dew
Remodel Addition
Rept. ix
Renewal
Total Floor Area Number of Stories
. foot shed Basement
What will structure be used for
applicable)'?
If use 'is multiplefamily apartment how many unit
Estimated cost -,f- 5,000,R5% rX .3 7 57--
Height of Building
�r
Firfished"O*meat
(include name of busi
3 0
UBC Use Ciassificatxon
Tax Code Building Tyke Zane
9
�7 e
Building Permit Fee"5
Plumbing rmit Fees
Water & Sewer Hookup fees
Signature f Applicant
Signature of BuildingInspector
Issue. by
Plan Check Fees
Pigging Permit Fees
Other Fees
5
f
ni
r]
W.
M
�s
70
z
4
A
J
m
C
0
z
AN
D
0
A
m
A
J
m
m
A
v
m
a
0
m
r
w
C
F
0
m
0
❑ X
Ew
m
�J
CIL
Li
z
m
m
M M
z
m
a
Not
0
0
z
m
J N
4�t
M
i
0
C3
W
�r
Jr
4F
i
i
70
z
4
A
J
m
C
0
z
AN
D
0
A
m
A
J
m
m
A
v
m
a
0
m
r
w
C
F
0
m
0
❑ X
Ew
m
�J
CIL
Li
z
m
m
M M
z
m
a
Not
0
0
z
m
J N
NAME OF BUSINESS: 71(
LOCATION:
TYPE OF BUSINESS:
PERSON 'LIN
CITY OF' REXBURG
BUSINESS LICENSE APPLICATION
REXBURG ADDRESSO16 *,�l ��
OTHERADDRESS:
IV IQ 6 02 M! j V COMM
DRIVERS LICENSE #:
STATE.
� � f
BUSINESSPHONE
BIRTHLATE Is
NEAREST FRIEND RELAT I, ` V\ _ r
name
--
address
REFERENCES IF NEW BUSINESS.0
COUNTS
V
1 YV
I understand that the building I own or am renting for my bus-Lnesswi l l be
required to comply with theU.B.C. Codes and the . F # ,. Codes and meet all
safety regulations required by these
SIGNATURE.
AMOUNT OF LICENSE.
Date of Application,.Is
IRE INSPECTOR
pn� k
DATE
WASTEWATER INSPECTOR DATE
DATE*
INSPECTION F
APPROVED- CITY CLERK
DATE
3UILDING INSPECTOR DATE
HEALTH INSPECTOR DATE
(Applicable to food services)