HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00194 - 280 Baldwin - SFR4paxeugp
CITY OF
a o n nXBURG BUILDING PERMIT FORM
1tC a�.�dre,rere 130
Arnsrfm5 (Smile CN,anlurdty
BUILDING APPLICATION
New SFR Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use,
Pernalt Nmnber; 17-00R4 00R4 o Plumbing Pea Pald
1. Property Owner
Name: rill K� fi ` ftw
Name
Address: 265"It- Zai City: State: 1_ Zip Code: g3�tla
Phone: IT,)m-11-11 ENlall:
Under Idaho Building Code, a homeowner is allowed to (to work on Buell, awn !tome.
Are you a homeowner doing work on your own home?
0 Yes (Skip to N3 and complete the Homeowner's Exemption)
1 am working with the homeowner
•L, Plumbing , dractor
Business: e5 " %,w6""` IteStateLicenseil: PI-91-c'"P5 4lip,: ///5c)//*
Addres"A y4wou-.1 Zip Code: 9C1
Phone: Zoe 5 35 /' Small: llc%v'ot a,n l e r & mitis+w. ee+
Conta(t/Rep. Name: ec) o, Phone:
Plumbing ConEraeforAuthoilzeil Signatiu'a; d Date: .�
Acopy ofyour• state regisn•atlon/llcenseIsrequired to a or, file. lfthlsls)frsttlmeyouhovedonetvorkIntheCityofftexburg,pleaseprovide
a photo copy ofyourlicense, lfyauare unsure ifyourlicense Isuni le, pleaseBleckwiththe Penult Technfcionbycalling (200)372.2341.
3, 11
dre s:tDesc2riptioll &
Address: SAVI w INCN-OR- [,at 4: Lt Blocl<t!: � Subdivision:
Description of work: N CA�- tk;zl L
0 New SFR Construction: x 49 4 sq. R,
12ees for now consn•uctfon ora charger! hy.cgunre footage; Up to 1,500 sg.)L = $130. $65 for each nddltlonnl1,000 sg.)E arportlon
thereof.
o Upto1,500sg.ft.=$130. Upto2,500sgft.=$195. Up to3,500sg.)t.=$260. Upto4,500sg.R,rr$325,etc, (i.e.(I
home Mill 3,675 sq. )t, wfll be charger! $325)
0 Hydro nc (In -floor) Heating: 0 Yes WNO
e Note that hydronicheatfngisnottinciudedlnsguorefoolagecostsmrdwill bechmQed$65r($loxgofmarnfolds/zones).
APPLICANT'S SIGNATURa, CERTIFICATION AND AUTHORIZATION: Under penallyofporlury,l herebycmllfy that l Imes read this application and slate that thoinformatlon herein
Is correct and I swrar that any Info n atlon which may hownfter be given by the In hearings before the Planning and Zotdng Cannulssion or nm City Council for the City of Rexburg
shall be lndliftd and oNren. 1 agree to comply with all City wgnhlieus And State Innis relalingto ilia subject matter of this application and hcrebyauthorized representatives of the
City to outer upon the aboveanentinned properly fol- InspMlanspnrpnsrs. NOTM The buildhngoOlcbll rally revoksa permlt ml approval Issued under the prnvldaue orlho 2012
International Code In cases of any raise statement or lnlsrepresenlallnnaf(naD, the application or on the plans on whltb the perndt or approval rms based. Perm11va1dlfnot
started within 1110 days. Permit vold Ifwmk slops for 100 (lays.
Applicant's None (print):'r6WIr- S1- __ -Signature: _ Data: _ `'V5/1)
Inspections const be called In before a AM on rho day Ilio Inspection Is repuesled Inspection requests called In after 0 AM will boscheduled for the next business day.
Impact Ion INOlino- (200) 372.2344 wmeroxburg•nrg PormU Techukhn- (200) 372,2341