HomeMy WebLinkAboutAPPLICATION MECHANICAL - 16-00612 - 1181 S Yellowstone Hwy - FrescoCITY OF
REXBURG BUILDING PERMI~pd.~~~~ (!!Q]
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440 America's Family CAJmmunity
For Office Use l \.t-CP\o \-:# Permit Number:
1. Property Owner
BUILDING APPLICATION
Miscellaneous Mechanical Work
Name: r~c:e><'D \? JL£,~c. ~~ .~
0 Mechanical Fees Paid
Address: City: &~~l.UfQ State: (~ Zip Code: ._) Phone: 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?
0 Yes (Ski.p to #4 and complete the Homeowner's Exemption)
't)Z[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: '~~ ~e;.l .. /~~cS;._' LLC__ State License #: ~Y:,-C..-L\cg.f Exp.: y\ ·~ \:1
Address: ~rr=, ~ 7.Q:-) it~ City: .\l.o 1ck "?Q.Ar\L_ State: 0\ Zip Code: 8t--\3l <;;:-
Phone: \.-~ d.t d@;·· . 14£--S.. 'Sio3-\Chtc'""l
'\:---x~one: Email: ~~.~A~ s06)11"M4.\' .\.-bcd'W\.
Contact/Rep. Name: ~l''1.4c\. 0 '/ L\"&-Of?t4-Cf..~~ail: <;,.CL~
Mechanical Contractor Authorized Signature: aJ ~l0YI--v."' _ _....,.. Date:
A copy of your state registration/license is required to be;; file. If this is the first time you have done work in the City of Rexburg, please provide
a photo copy of your license. If you ore unsure if your license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: ~~e~c.£.:2 ·OR· Lot#: -Block#: --Subdivision:
What type of Property: 0 Residential ~ Commercial
Cost of job: $ ?le/19J
Description of work: \.\\]~
4. Fees: Check all that apply:
¥-Furnace or A/C = $65 0 Fireplace/Solid Fuel Burning Unit:
0 Gas Line = $65 0 Built-in= $130
0 Water Heater= $65 0 Free-standing= $65
0 Miscellaneous/Requested Inspection= $65
Inspection fees can be bundled upon request Re-inspect fees will be enforced if inspection requests exceed fee totals.-
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury,l hereby certify that I have read this application and state that the information herein
is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexbm·g
shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued underthe provisions of the 2012
International Colle in cases of any false statement or misrepresentation of fact in the applicoticm <:IT on the plans on which the permit or <rpprrNal was based, Permit void if not
started within 180 days. Permit void ifwo for 180 days,
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day,
Inspection Hotline-(208) 372.2344 www.rexburg.org Permit Technician-(208) 372.2341