HomeMy WebLinkAboutAPPLICATION - 92-00023 - Madison Memorial Hospital - Xray room RemodelDate of Application
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APPLICATION FOR BUILDING PERMIT
CITY OF REKBURGI IDAHO
CONTRACTOR
Street Address
Street
Address
, di..i
Mailing Address MallingAddress
City, State
City State
Zig Telephone Zig � Telephone
{ or Eng ir1Ida. Lic
GAL DESCRIPTION (ATTACHCOPY IF NECESSARY
Lot No Block Subdivision
No a
project Information (To be completed by applican
LCITY OF REXBURG
Residence Gom, Educational Gov't �teligi
mous
Fence
Structure:
Patio Carport
New Remodel Addition
Garage Awning
Repaa"_r Renewal
Total Floor Area Number Height of Building
footer inished Basement l shed Basement
.t will structure be used, for include name of business if
applicable)?
If use is multiple f am' l how. any units
Estimated costo/,`a?
_ .
Use class
Grow Type Construction,
.i. *t
Fees }
Pring Permit Fees
Water ewer Hookup fees
_
Signature Apel is ant
signature of Building Inspector
Issued by
-Use Zone
P 1 n, Check Fees
�Ii
niqaIna Peri Fees
other Fees