HomeMy WebLinkAboutAPPLICATION - 17-00315 - 2399 N 4000 W - New SFR MechanicalVA B
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CITY OF
REXBURG
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BUILDING PERMIT FORM 41U
Updated 2/2017
Building Safety Department
City of Rexburg
35 North Is' East
America's Family Community
L D Rexburg, Idaho 83440
t H
BUILDING APPLICATION
Miscellaneous Mechanical Work
For Office Use
Permit Number:
❑ Mechanical Fees Paid
1. Proprty Owner
Name:� � hr,�r �D�,) `'i� Y`WSC'i1 �_ Zi Code:
AddresStates: �11ci N L4 "�•` Wy City: z e � C1i p
Phone:70ZI t Z�� Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to section 4 of this application and complete the Homeowner's Exemption page as well)
No, I am working with the homeowner
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business:
Address:
Phone:
Contact/Rep. Name:
State Lic
�4A&C'���Exp.:
Crare 11 _ Zip Code:
Mechanical Contractor Authorized Signature: lease rovi
A copy ofyour state registration/license is required to be on file. If this t the first time you have done work in the City of Rexburg, p p
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address:
What type of Property: Residential
Cost of job: $ 00 Gv
Description of work:
-OR- 1,ot #: — Block #: _ Subdivision:
❑ Commercial
4. Fees: Check all that apply: 4 Fireplace/Solid Fuel Burning Unit:
Furnace or A/C = $65 / Built-in = $130
Gas Line = $65 o Free-standing = $65
❑ Water Heater = $65 ❑ Miscellaneous/Requested Inspection = $65
F��o ,-ten he bundled upon request. Re -inspect fees will be enforced if inspection requests exceedfee totals.
Inspecttu«7c;uil ��••
I have read this
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APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certifythand'Loning Com nisslon,c,rlth<' CitysCouncil for the city oflRexbeu
is correct and 1 swear that any information which may hereafter be given by me u� hearings before the Planning
hereby authorized representatives of Rex of
ter
is
cation
1 agree to comply with all City regulations and State laws relating uild building the bmay evject toke of permit on app is ssucd under the provisions of the 201
shall be truthful and correct, g property for inspections purposes. NOTE: The g
City to enter upon the above-mentioned prop y application or on the plans o ich the permit or approval was based. Peru'it void it not
International Code in cases of any false statement or misrepresentation of fact in the
started within 180 days. Permit void if work stops for 180 days. nA '/A I Date:
Signatu
Applicant's Name (print):
requested, Inspection requests called in after 8 AM will be scheduledPermit Technician (208) 372.
Inspections mus[ he called in before 8 AM on the day the inspection is rew w rexburg.org
Inspection Hotline - (208) 372.2344