HomeMy WebLinkAboutAPPLICATION, RECEIPT - 17-00407 - 1161 W 5000 N - County MechanicalBuilding Safety Department
C11 Y (IF RE001 BUILDING PERMIT FORM110 City of Rexburg
e "nelnV201 35 North 1st East
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HRYANT HAI?RIS
(FIANI; YOU AND 8r`1VE A 01"r "Ay
BUILDING APPLICATION
New SFR Mechanical
City: ��� State:
Email:
is allowed to do work on their own home.
wn home?
Homeowner's Exemption)
.N-, ,air, wui fang with the homeowner
Rexburg, Idaho 83440
❑ Mechanical Fee Paid
Zip Code: F-7 114-2
2Mechani l gntractor �
Businessvig danbr�g —State License�(z!/e, Exp.: G-3- 201
Address: E d 25-`% city: KP_4_4'�f5 State: Ed Zip Code: 93 �'`fd
Phone: 2e e- -3S%"- Email: rX,e/` 4 tc Parr/-she-/r,i=P . 12 ems
Contact/Rep. Name: f Phone: —T Email:
Mechanical Contractor Authorized Signature: Date:
Acopy ofyourstate registration/licenseisrequired tobeon file. Ifthis feffrsttimeyouhavedoneworkintheCityofRexburg,pleaseprovide
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: If P 1✓ 0/�o -OR- Lot #:
Description of work: Ale ,/ 1_4y klC I
X_SFR Construction: �7-� sq. ft.
Block #: _ Subdivision:
Fees for new construction are charged by square footage: Up to 1,500 sq. ft. = $130 +$65 for each additional 1,000 sq. ft. or
portion thereof
0 Up to 1,500 sq. ft. = $130. Up to 2,500 sq.ft. t. = $195. Up t3,500 sq. ft. _ $260. p to 4,500 sq.. t. = $325, etc. (f e. a
home with 3,675 sq. ft. will be charged $325)
❑ Number of Fireplaces:
• Note that fireplaces are not included in square footage costs and will be charged $65 per inspection.
❑ Hydronic Heating:
• Note that hydronic heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of
manifolds/zones)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state that the information
herein is correct and I swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of
Rexburg 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. NO'T'E: The building official may revoke a permit on approval issued under the'
provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was
based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): [ e"raN Jo t( f/50/ Signature:/, D
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after a AM will be scheduled For the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341