HomeMy WebLinkAboutAPPLICATION - 16-00791 - 1280 S 5th W - Furnace & Ducts12/0212016 10:15 First Call Jewel ffAX)12085292793 P.0011002
as"alt°`"a CITY OF Building Safety Department
1YLrt1�17y1\G BUILDING PERMIT FORM 4�� City of Rexburg
Ca a'd.wiclanae 35 North let East
AmaAmlPo,nnycmampaity Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Mechanical Work
For Office Use
Permit Number; -0074 .❑ Mechanical Fees Paid
1. Proper Owner
Name: Flher; re Y1
Address: a'~ Liry:�� State: � Zip Code: =-� kfl-
Phone: - Z 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 #4 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: StAtel L(ce #; rr vyc �� (O 1 SZ Exp';
Address: �• City: �st;4 � Zip code: 34Cf l
Phone: 2 Z Email: e- A m4gaUG�eAt_fA 211
Contact/Rep. Name: .Phone: Z Email:
Mechanical Contractor Atithorized Signature: r 64 2lN rkA Dater
A copy ofyour stote regi8tratlon/ilcitme is required to be on fa, ifrhis Is the prst thneyou have done work hl the City ofRexbtag, please provide
a photo copy ofyour license. Ifyou are unsure Ifyour license is at file, please check with the Permit 7'echnic:un ey calling (208) 372.2341.
3. Project Description
Address: zzoz_5_,thNU' OR- Lot #:` Block #:_Subdivision:
What type of Property: 13 Residential O Commercla
Cost of job: $1044%
Description of work:
4. Fees: Check all that apply;
.pP Furnace orA/C = $65 ❑ Fireplace/Solid Fuel Burning Unit:
El Gas Line = $65 o Built-in = $130
Cl Water Heater = $65 o Free-standing = $65
❑ Miscellaneous/Requested Inspection $65
Inspection fees can be bundled upon request. Re•Inspacefees will be enforced Ifblspectfon requests exceed fae totals,
APPLicANrssieNATURs,CBR71PICATIONAMOAUTHO812ATION: Under penalty olpedury, I hereby nraythst l have read this application end state that the Information henln
oeorreet and I swaarthatanylnformanon which may hereafter beglven by Me In hearings before the Planning and Zmdhgcommlealnn or the CltyCountU for.heCgY of Rabulg
shall be truthful and correct. legroom camplywlth 511 City rogulatitaw and Sute laws relating to thasublectmatnrofthlsapplimtton end hembyaumodaed reprannottvaa0r
Cltym enter upon the abow•mmtloned property for inapactlanepurpsoes. NOTEthe
. The b511dingoUWal may revoke a Permlton approved Issued underthe provlelossof the2012
International Cada In cans ofany relsesawmmtor relenpresentation of fact In the appliesthm *ran thepigniyo which theplrmlt ornpproval westn nd. Permltveld Uaot
smrtadwlthlnle0days. Permltroldlfwurkstupsfar26Uduys, 1t 11 `
. , .- rnr��ar�Q��1�[�:�•.. ��"�-�i!i�111�a11�1!�►.1.11\\�11► � r - -
Inspections must be ailed In before BAM an the day the ImpIN31011 Is requeatad, Inspecten requests oiled Inalter 8 AM will ue scheduled fnrtbe nestbusinass day.
Inapeetlen HOthhe- (2081372.3344 www.resburgprg Permit Tochnlchm. (208) 372.1341