HomeMy WebLinkAboutAPPLICATION - 17-00235 - 3618 W 2000 N - New Mechanical InstallCITY OF
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BUILDING PERMITFORM
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BUILDING APPLICATION
New 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 Owner
Name: �;ANI 01J11!re, ---i
3 iZ1State: �-,-t-Lip Code:
Phone: 24,', 1- 7 - � 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 section 3 of this application and complete the Homeowner's Exemption page as well)
ANo, I am working with the homeowner
2. Mechanical Contractor
Business: Vic(+.75c 4e_4-Vl.l h 1-1-C- State License #: Py c- c 13 Z 7 Exp.: a-
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Address: ` k- w'd 100 J6nX-K c i Oc Ic City: �k v-- l ,,, rh State: T -t> Lip Code: CS Y Y�
Phone: _4_c 1H_- S iC o 5`7 S Email: ]i G 1, ,,.,, - i,{.. T , C1 we 'l rxa, \
Contact/Rep. Name Phone: - 3 c: _452` Email: �,.,sa ���s, ; r4� r✓ Z0.-1
Mechanical Contractor Authorized Signatures r �c.c` y` _ i. L,! -c t c s Date: n?f2�
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A copy ofyour state registration%license is required to be 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 license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: 56,-/e I.-eL f 2cZY9 -OR- Lot #s Block #: Subdivision:
�� — — /
Descriptionofwork: K) ,,I Cc, 2r- (f.C+A,?1e c r vrN.4ti- >,,[i , if, 9t �C�. , 17 r►, I�, �
13`SFR Construction: ii c00 sq. ft.
* 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.
o Up to 1,500 sq.ft- = $I30 Up to 2,500 sq. ft. = $195. Up to 3,500 sq, fr. = $260. Up to 4,500 sq. f r" = $325, etc: (Le, a
home with 3,675 sq. fl" will be charged$325)
❑ Number of Fireplaces: I_
* 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 squarefootage costs and will be charged and additional $65 + ($I0 x # of
manifolds/zones)
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 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 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 eases 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): ,fin; Dfe Ill, 7-,>% --' Signatur�1tL' � 1i t i I.1. N, Date: rll7+:, c `7,-t 7
Inspections must be called in before 0 AIN 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 - (2 03) 3 72.2 341