HomeMy WebLinkAboutAPPLICATION - 17-00111 - 122 N 1st E - Fireplace & Gas LineoQ4exetrRc,
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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: 0-00111 Mechanical Fee Paid
1. Property Owner
Name: R ICV . PPal"Sfl ti.
Address: 122 ,d 1 E , City: State:_ Zip Code:
Phone: -'i v3 Z Sr$O Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
)Po, I am working with the homeowner
2. Mechanical Contractor /�
Business: (3-0- ,.t - \k -.-C(' •ra k4 ,$,State License #: 'tel1[0 pr Exp.:
Address: 374W V—? 1 1 r.I, City: r: :F� Stated Zip Code: !S 2 N al
Phone: 13 -HH -71 Email:
Contact/Rep. Name: ? hone:
Mechanical Contractor Authorized Signature: ' 'v`� Date:
A copy ofyour state registration/license is required to be onfile. If this is the first time you have done work in the City of Rexburg, pleas 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: )'1'l Fs(_ I l
Description of work
❑ Remodel Cost: $
a Feesforremodels are charge bycost:
o First$10,000 = 2% + $60. From $10,000 to $100,000 = 1% + $260. Above $100,000 =.5916 +$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, l 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 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.
Applicant's Name (print): fi,4 P - IJ I Signature: Date:
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 - (2 08) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341