HomeMy WebLinkAboutAPPLICATION - 17-00078 - 2361 N 4000 W - County New SFR MechanicalCITY OF
J EMIMG BUILDING PERMIT FORM 110
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Amerira3 Family Community
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 15t East
Rexburg, Idaho 83440
For Office Use
Permit Number: I7 -o e a 7 S/
Mechanical Fee Paid
1. Property Owner
Name: y
Address: 3rl / il/ !� Ct'o<<' City: Ir Wellz State: �O Zip Code: C1,0
Phone: 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)
❑ No, I am working with the homeowner
2. Mechanical Contractor f
Business: Mtik� /f�M� � G L�'c��� State License #: �/S /`o Exp,;
Address: /fes/W etlg City: 7o tit «/ State: Zip Code: _ �7�7 9 YS,
Phone: l08,, 2v/ -//Y2 Email: /A-4�Ci�� r
Contact/Rep. Name: Phone: 1W ;�L//f Email:
Mechanical Contractor Authorized Signature: i _--- Date: <Y
A copy ofyour state registration/license is required to be on file. If this iV.l(e*st time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. lfyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Desction
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Address: 2 3 / h' 5'667i 20" -OR- Lot #: Block #: Subdivision:
Description of work: 11 ---re X< -"64r /-
❑ SFR Construction: 4 ooc; 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.
0 Up to 1,500 sq. ft = $130. Up to 2,500 sq. ft. = $195. Up to 3,500 sq. R. = $260. Up to 4,500 sq. ft. =32 etc. (i.e. a
home with 3,675 sq. ft. will be charged $325)
�] Number of Fireplaces: S
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• Note tha[firep/aces are not included in square footage costs and will be charged $65 per inspection.
❑ Hydronic Heating:
• Note that hydronic heating is not included in square footage costs and will be charged and additional $65 + ($10 x N 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 mein hearings before the Planning and Zoning Commission or the City Council for the City of
Rexburg shall be truthful and correct Iagree 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.
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Applicant's Name (print): /0/f Oc Signature: T/ Date:
Inspections must be called in before 8 AM on the day the inspection is requested. InspectiofFre estscalled 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