HomeMy WebLinkAboutAPPLICATION - 17-00033 - 6431 S 1650 W - New County SFR Mechanical���0� p6XB0,pC,y
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CITY OF
REXBURG
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Aaierlco's Family Community
BUILDING PERMIT FORM 110
Updated 10/2016
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Property Owner
Name: deyor) LcaVld cy)
Address: (9i-I3I S. JUSQ V City: bUL State: T Zip Code: 73000
Phone: ZOI -3c-'�1y 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)
0 No, I am working with the homeowner
2. Mechanical Contractor
Business: —Ein C, State License #: I-AVG"Ci'1S12 Exp.:
Address: ` ? C/ SIJ J 4V) St City: State: Zip Code:
Phone: 209 5Z -Z'- `33 Email:
Contact/Rep. Name: ZCtAn Phone: SZZ X3'1 Email: oV1I h 5 S I ap yy-�fbY) Mm
Mechanical 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. If you are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
Description of work:
❑ SFR Construction: 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.
o Up to 1,500 sq. f t. = $130. Up to 2,500 sq.ft. t. = $195. Up to 3,500 sq. ft: = $230. Up to 4,500 sq. fl: = $295, etc. (i.e. a home
with 3,675sq. ft. will be charged $295)
❑ Number of Fireplaces:
Note that fireplaces are not included in square footage costs and will be charged $65 per inspection.
3ydronic Heating:
• Note that hydronic heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of
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 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): 8r.,+- P C,7"— Signature:�Je�07, Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in atter 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341