HomeMy WebLinkAboutAPPLICATION & DOCS - 05-00303 - 732 Centennial Loop - Madison School DistrictBUILDING PERMIT APPLICATION
19 E MAIN.. REXBURG, ID. 8;440
2 0 8-.i5 9-0 2 0 X 3 2 2
PARCEL NUMBER:
Please complete the entire Application !
If the question does not apply fill in NA for non applicable
(We wild provide this for you)
SUBDIVISION, LTNIT#
40 (Addressing is based on the information - must be accurate)
OWNER:
PROPERTY ADDRESS:
BLOCK# LOT#
o t�L ll 1
�2rmipmCONTACT PHONE #
3z1
cel. nT�e r?rr +,�q L_ 4LO0L
C* , 1> 1 V 1. -:!nsj
V_
r
PHONE #: Home �( )_ _ WOrk Cell(
OWNER MAILING ADDRESS: c2,q0 /V . t � CITY:
F 600_4wSTATE: 113 ZJ90
EMAIL FAX ,5
APPLICANT (If other than owner)
� (Applicant if other than. owner, a statement authorizing applicant to act as agent for owner must accompany this application)
APPLICANT II�iPORMATION: ADDRESS CITY:
STATE; ZIP EMAIL
PHONE#:Home ( ) Work ( )
CONTRACTOR:
L. .
Cell
.FAX
MAILfNG ADDRESS* rL� /1S BtA3n.¢.tCITY
P"JSTATL
PHONE: Home# Work# Cell#
EMAIL FAX
ux_:r-
Z,IP
How many buildings are located an this property?
mid you recently purchase this property? NoYes �� yes give owner's name)
Is this a dot split NO YES (Please bring copy of new legal description of property)
PROPOSED USE: � � �1. C� �
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Gar Vie, Commercial, Addition, Etc.)
APPLICANT" S SIGNATURE., CERTIFICATION AND AUTHORIZATION:
that 1. have read this appficat*We -
i im and state that the inform tl' on herein is correct and 1 swear that an i of rl ati � ���h �r
y rr
r bme
ivii bin hearings before thePlanrung and Zoning i n r the 1oune'orte 'ty of Rcxburgal be truthful andrrt. l agree t
iwith all City regulations and State laws relating t_ the u�t matter t lapplication and hereby ut rT r r r��i'T the it
of to enttr
upon the above-mentioned property for inspect* purposes. TEF The
bultdl' g official may revoke rmt oti approval issued under thepr
provisions fib�ntrt� nl in f
rly false t,tr.n
t or mi b srresentafion of fact in the .platin or on the plans on wh*ti the
pen -nit r rv.1 was based. Permit void `f -not started within 180
. Permit 1 if work t r 180 days.
Emwm_ j � 27.. " eC 'el v -N
S�gr�at�zr�e 4�'OW-ner7Xp'�TICary?'�
_R/27. -V
DATE
Baa you prefer to be contacted bv fax in or nhnnp9
SIT MUST BE POSTED ON CONSTRUCTION SITE I
Man fees are non-refundable and are paid in full at the time of application beginning JanuyrE 1, 2005.1
City of Rexburg'sAcceptance of theI n review fee
� does not constitute plan approval
"Building Permit Fees are due at time of ppficati n * "Bu ldin
Permits r- iI you cheek does not clear*
` Please complete the enti'., e Application!
If thequestion does not apply fill in NA4 for no
^ NAME � f`JS fJ � t_y.}pc"� i._ � 1 �1 ..�v z-1 L i � •,��
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units-:�� Parcel Acres:4 .
SETBACKS
FRONT SIDE � 2
SIDE I �' BACK
Remodeling Your BuildingAlIome (need Esti"mate) $
T 4ppficable
MKI&
&h)r D EnT- PirO36XT...
Permit#
SURFACE SQUARE FOOTAGE: (Shallinclude the exterior wall measurements of the building)
FI'rst Floor Area f q16>
Second floor/loft area
Third floor/loft area
Shed or Barn
Water Meter Count:
Unfinished Basement area "7 li�,
Finis�aed basement area
Garage area
Carport/Deck {34" above grade)Area
Water Meter size:
Require d!!!
PLUMBING
Plumbing Contractor's Name: 21.1.j A"Z-W09A usiness Name:
Address CityJL /}�2_�-1 tate [a,4�-b Zip
Contact Phone,-, { )
Email
FIXTURE COUNT' Oncludinz roughed fir -
,tures
Business Phone:
Fax
f
}
Clothes Washing Machine Sprinklers
� Dishwasher Tub/Showers
� Floor Drain - Toilet[Urinal
� Garbage Disposal 1 Water Heater
� Hot Tub/Spa 0 Water Softener
Sinks
(Lavatories, kitchens, bar, mop)
dumbing Estimate $ (Commerchad. only)
LicenseSJCF nature o f L'
icensed Contractor number Date
The City of Rexburg'smn�fees � 1" the �
4
Please complete the entire "`Plication! If the question does not amply fill in NA for no
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Re uIred
Mechanical Contractor's Nameb
Address City State 701p
Contact Phone: Business Phone: � }
Pennit#
—MIe� � N
.-V� 0-n"F1 Business Name:
f Email Fax
a f
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
0 Air Conditioner
looe Bath Fan Vents
0 Range Hood Vents
C) Boiler
Cl Cove Stove Vents
I"
Decorative Gas Fireplaces
� Evaporative Cooler
� Exhaust or vent ducts
?A
Fuel (gas) piping fixtures or appliance outlets
Fumace
Fumace/Al'r Conditioner combo
_Heat Pump
�
Incinerator
� Pool Heater
�1
Heat (circle all that apply) GasOil Coal Fireplace Electric
f
Space Heater
Unit Heater
Mechanical sizing Calculations must be submitted with Plans & APP lication
Pont of DelYvery muse be shown on Plana.
Signature of Licensed Contractor
Requ*red!
License number
Date
The City ofRexburg's permitfee schedide is the saes as reqzdred by the j_5tate of Idaho
5
u!
NKENO onto an a saw MIEN SURE Ono MEN Eno MvmMKM ENO Eno Eno Nommano MENOMONEE SESSER Eno Nonni
Excavation & Earthwork:
Concrete:
Masonry.,
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings,.
Plumbing:
Heating:41� p p i
Electrical:- �'j 2 -i v� �l � E -k,
SUBCONTRACTOR LIST
L 21-- -sm.,
rg
Cly �
Special Construction
(Manufacturer or Supplier)
RoofTirusses. �jG�i�ca (:/�sL,t���
Floor/Cefling Joists:
Siding/Exterior Trim;
Other:
C�
50
D
CITY OF ..SINGLE G11E FAMILY
RESIDENTIAL
R,EXBURG,. Cityof RexburgAAEftIG15 F;�.MftY Cc�?�1N[L�h f � ��
Department of Community Development
29 E. Main St. l Rexburg, ID. $340
Phone (208) 359- (208)359-3022
CITY OF SINGLE FAMILY RESIDENTIAL
1�-EXBUT�G-
City of Rexburg
I ]MERIC VS I INIVULY COMNAU N I Y Y
Department of Cammunity -D eve,,Opment
19 E. Main St. / Rexburg, ID. 83440
a -- Phone (2081.1-59--lon / pQx, oaQ) izn I