HomeMy WebLinkAboutAPPLICATION - 17-00055 - 815 Johnson St - Garage RemodelCITY OF
REXBURG
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America's Family Community
BUILDING PERMIT FORM 1�2
updata 1012016
BUILDING APPLICATION
Single Family Residence Remodel
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: 1'7_0O0S'5 Zoning: (>)29 Application Fee Paid: O $100
1. Property Owner �J
Name: 0� WX4
Address: ? I Joi tnl:o, i v G' City: State: 37d Zip Code: g yc/ 0
'Z�Email:
D I N I t+Icr�Z
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 #4 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Applicant
Name: Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name:
3. General Contractor
Name: Registration #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date:
A copy ofyourstate registration/license is required to be on file. If this is the first timeyou 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.
4. Project Descri tion
Address: �� J6/fhf5V1A1 S/
Project Description: n"&)5cs �d✓ 7-01e- 6 CST
• Estimated Total Cost: $ 7 000
• Check All Included in Scope of Work:
❑ Mechanical Work Cost: $ C7 ❑ Electrical Work Cost: $ 7�0 ❑ Plumbing Work Cost: $
Note: Any contractors involved will need to fill out their respective application.
• Fireplace(s) Being Installed? ❑ Yes KNo
Building Permit fees for remodels are charged based on cost. The application fee applies toward the fee total. For details on how fees are
calculated, contact the Building Department. There will also be a plan review fee totaling 10% of the building permitfee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that have read this application and state thatthe information herein
is correct and I swear that any information which may hereafter he 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 ofthe 2012
International Code in cases of any false statement or misrepresentation of fact in the application or 0th tans 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): (6,1V Signature: �Z62Z. lz Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection rEquests called inbRer a AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
C I TY OF
REXBURG
America's Family Community
HOMEOWNER'S EXEMPTION
Building Safety Department
City of Rexburg
3S North 1St East
Rexburg, Idaho 83440
As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your State
registration number or your exemption from the State registration. Please fill out this form showing your
exemption and send it with your permit application.
Idaho State Statute allows a homeowner to do work on their own residence:
An owner performing construction on the owner's personal residential real property, whether or not occupied by
the owner, provided however, this exemption shall not apply to an owner who is otherwise regulated by this chapter
who constructs a building, residence or other improvement on the owner's property with the intention and for the
purpose of promptly selling the improved property, unless the owner has continuously occupied the property as the
owner's primary residence for not less than twelve (12) months prior to the sale of such property;
Title 54, Chapter 52, Subsection (2)
I hereby certify that the above information is true and correct to the best of my knowledge.
i
Sign ture
IJV //A/ �Vl L -1--P'172
Print Name
Date
Permit Technician -(208) 372.2341 www.iexburg.oig Revised 10/2016