HomeMy WebLinkAboutAPPLICATION - 17-00194 - 280 Baldwin - SFRE ex•ugo
Amer
n� •b CITY OF
` REXBURG BUILDING PERMIT FORM 100
C W updated 1012016
icas Family Community
BUILDING PERMIT APPLICATION
New Single Family Residence
Building Safety Department
City of Rexburg
35 North lgt East
Rexburg, Idaho 83440
For Office Use
Permit Number: 17-0019t4 Zoning: Application Fee Paid: 11$500
1. Property OwJp�er
Name: �`aC��! ft�YWd
Address: 'Je *L%Xlore thm*9t Lb1 City: V&>J'0Vr i State: I(% Zip Code:
Phone: Sag -21(L, —� Email: -�fyrc ��,('-Fy�f%totv.�n•cov�
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to 44 and complete the Homeowner's Exemption)
o, I am working with the homeowner
2. Applicant
Name: S4_Y1-*_ O -S 4260\1C Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name:
3. General Contractor
Name: sa htt ed Registration #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date:
A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address: 144 D1W&.tn -OR- Lot#:Block#:$ Subdivision: F'I41(Lt$ Syygn
Project Description:
I
• Square Feet: Building Total: �G24 sq. ft. • # of Water Meters: Water Meter Size:
o Main Floor:I) 7S sq. ft. • Fireplace(s) Being Installed? Fd' Yes ❑ No
o Additional Floors:�1, 4-1 sq. ft. • Hydronic Heating Being Installed? O Yes No
o Basement:
Finished 953 sq. ft. Building Permitfeesfornew homes are chargedbased on square
Unfinished sq. ft. footage and the City's estimated valuation. Fordetails on howfees
o Garage S4I/ sq. ft. t� are calculated, contact the Building Department There will also be
• Estimated Total Cost:$ aplan reviewfee totaling 1095 ofthebuildirlq permitfse.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the Information herein is correct and 1 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 Rexburg shall be truthful and correct. 1 agree to comply with all City
.,letters and State laws ceded, to the subject matter of this application and hereby authorized representatives ofthe City to enter upon the above-mentioned property for Inspections purposes. NOTE: The
building official may revoke a permit on approval issued under the provisions of the 2012 International Code In cases ofany false statement or misreprexamadon of fact in the application or on the plans on
which the permit or approval was based. Permit void ifem started within 180 days. Permit void Irwork stops for 180 days.
Applicant's Name (print): Tafe-S I y4i Signature: 1 e� /J Cis" Date: `
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after B AM will be scheduled for the next business day.
Inspection Hotline- (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341