HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00107 - 523 Edith Cir - RemodelCITY OF
REXBURG
Amerlca's Family Canmunily
BUILDING PERMIT FORM 131
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BUILDING APPLICATION
Remodel SFR Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: I-Aoo lQ Plumbing Fee Paid
1. Property Own -
e
Name:—AJ,,,
Address: de -T k Cto+ City: ReX b ry State: 1 Zip Code: 23 3
Phone: (r7 ` �l `f 5 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?
❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
kNo, l am working with the homeowner
2. Plumbing Contractor CdNorl r 3epfre�
Business: Ike �daG. �,0I P/0"`H"I eD State License#: 603&-9Y Exp.: I2'3l
Address: X5 ici N dt'ff PL City: -1- F State: -L)Q Zip Code: 9'346 /
Phone: S61- `% iZ v- _'3 Email: 2-4&_i FPlo u. ber G6/, e AA
Contact/Rep. Name: L44ad Mer-2cw\ Phone: 569-- 9/74/3 Email: S,
Plumbing Contractor Authorized Signature: / � �/� Date:.3 -ZO /�
A copy ofyour state registration/license is required to be on file. If this is��t timeyou have done work in the City of Rexburg, please provide
a photocopy 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: 7-3 f J fl Cn !
Description of work: ��o eN -_ I
❑ Remodel Cost: $ ZY—
• 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 $60 far the first$10,000 and 1 °% of the remaining $5,000 = $60 + $50 = $110 total feefee110 total fee
MAR 2 0 2011
rlty Cs Rexburiy
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby a hat I have read this applic ion 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 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 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 ofthe 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 ifnot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print):Xcd0� 4 v) Signature: Z Date: ' ZO
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