HomeMy WebLinkAboutAPPLICATION - 17-00159 - 621 Island St - New County SFR MechanicaloYvtzau�c
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REXBURG
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BUILDING APPLICATION
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Building Safety Department
35 North l at East
Rexburg, Idaho 83440
For Office Use
Permit Number: El Mechanical Fee Paid
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1. rropert owner
Name: ��Cj� pfJG!%C'4 G _
Address:/ 1 otv;/i;e'yh'-1 Ca State:.Ib Zin Code o 3"12%0
Phone: & / Z5�9he� S f r Email:
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Are you allomeowner doing work on your own home?
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❑No.I am workine with the homeowner
2. Mechanical Contractor n
Business: � �4eh A'Jaw /�(4mb/ ,n A State license#: 5%?D/ Exp,; �L�
Aodress: D OBJ--�'&!y( qP 'irate: Lip t_ooe:'k�t/S (
Phone: -d 1.9 7 Email:
(Contact/ Rep. Name: )4$th,`S Phone''- �j0-,3`�15hrnail: 9��9i�/lr;^®.4IiC��'LYlI
Mechanical k 6iitractor Alit _ ��r/L Date: 3/=
.. .: aeon/liccuse is required to peon lila f this Is (lie first tine }ou hate done Rork in the Gtc of Rexburg.please protide �
a photo copti o1 your LICCIISV. if3011 are unsure li')OUr license is on file, please check pith the Permit'fecluneian ba calling (208) 372-2341.
Uoiect Description
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Description of work: AIP tU fVpme
ESFRConstruction: Nq.lt. 1
Fees for new construction are chortled by square footaee: On to 1.500 so. ft. =$130+$65 for each additional 1.000 sa. ft. or
Iportion thereof. 1
home with 3,675 sq. R. will be charged $ 1' c S t] i
i uNumber of Fireplaces: J 4 1
IWirtthat firenlnseq nrp.. not inrtlmdrsi In Cnonre..}'nntnnP.rsvQtq and Will hnv..tmroeA.VA np..r imnentlnn
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Note that hydronic heating is not included in square footage costs and will be charged and additional $65 +($10 x# of
manifolds/zones)
APPIICANI'SSKINATl1RE, 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 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 Slate laws relating to the subject matter ofthis application and hereby authorized
representatives of the My 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.
Applicant's Name (print): )/'OCY 9 Signature: Date:307317L-/7
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection request& called in slier 8 AM will be scheduled for the man business day.
Inspection Hotline - (208) 372.2344 wwwxexburg.org Permit Technician -(208) 3722341