Loading...
HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00169 - 615 S Yellowstone Hwy - Stones Town & Country - RemodelCITY OF REXBURG N+ Anu rica3 Family Community BUILDING PERMIT FORM 430 ",am 2/2017 BUILDING APPLICATION Miscellaneous Plumbing Work Building Safety Department City of Rexburg 35 North 1xt East Rexburg, Idaho 83440 For Office Use Permit Number: 17-091(,,C/ ❑ Plumbing Fees Paid 1. Property Owner Name: Lny 6-S 7-1'oj L(GT^rJ ray �J Address: Fi KiftJ��g ID 834No (DIS S• ��I,t-oN15•TzxJ� City: State: Zip Code: Phone: 2©13' 3S(o- q�*(e 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 4 of this application and complete the Homeowner's Exemption page as well) o, l am working with the homeowner 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. � Business: �C, L ^ t�Cl State License #: 13161 Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Pon Email: Plumbing Contractor Authorized Signature Date: 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: �D 1 S• �� l`I LcyJ S tit -OR- Lot #: Block #: Subdivision: What type of Property: ❑ Residential Xcommercial Cost of job: $ q I-Ie� Description of work: K. r-�6� r - Ac,1-f{fZCT0-,\ 4. Fees: Check all that apply: ❑ Gas Line = $65 ❑ Hydronic Heating= $65 + ($10 x# of Water Heater = $65 manifolds/zones) = $ ❑ Sewer Line = $65 ❑ Miscellaneous/Requested inspection = $65 Water Line = $65 ❑ Sewer Turnaround (septic to city) = $65 ❑ Lawn Sprinklers/Backflow device = $65 Inspection fees can be bundled upon request. Re-inspectfees will be ❑ Gray Water Systems = $130 enforced finspection requests exceedfee totals. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 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 me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall he truthful and correct. I agree to comply withal] 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. Permitvoidifnot started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): S LANZt G rgy e' Signature: Date:�7-� Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 All he scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341