HomeMy WebLinkAboutAPPLICATION MECHANICAL - 17-00107 - 523 Edith Cir - RemodelORF abUgC�
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C I TY OF
REXBURG
Amcricas Fmnily Communilp
BUILDING PERMIT FORM 111
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BUILDING APPLICATION
Remodel SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1 Property O.wiler
Name: vv\ CN.IY T_�_s
Address: 50 3 E it" City: FPxlouin State:! Zip Code:
Phone: ��y�� i 5 � 'l Email: &,Vy*X'Y)11 (1t010VO \ CAV`ICf ;. LXVVA
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 3 of this application and complete the Homeowner's Exemption page as well)
-It No, I am working with the homeowner
Mechanical Contractor
Business: fV5iCVI W(Nft:; S if6 5_-) "IV-, State License #:S 1u���Ci� P Exp.:
Address: ;"Iaq-c »' City: State: CA ) Zip Code: R5 MD
Phone: Email:tL`�iCYlY1C�YES:t1:4C JIv1C"C- r-.wlcrk�_. coy")
Contact/Rep. Name: Q9 °` Phone:( Cki3LI(e-OIT Email•
Mechanical Contractor Authorized Signature: 1 Date:
A copy ofyour state registration/license is required to e on file. If this is the first time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour icense is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description ' ^,
Address: X53 F&th C tcck
Description of work: Joackk`(vvyti ti'��Al.; �ii�(, `�� � ���`fP� . C �Gcr'�C� IJ.0 t�{ l� lrftAt . i(irlfzl,
❑ Remodel Cost: $ �� : M.00
• Fees for remodels are charge by cost:
o First $10,000 = 2% + $60. From $10,000 to $100,000 = 1% + $260. Above $100,000 =.5% +$1,160, i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total fee
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 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. 1 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 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.
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Applicant's Name (print): ��L i,\� Signature: Date: 5– 0 "
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