HomeMy WebLinkAboutAPPLICATION - 16-00749 - 402 S 4th E - Deck Replace and Shed Roofl exuu
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.d C I TY OF Building Safety Department
�Fo REXBURG City of Rexburg
> N 35 North 1st East
Americas Fmmily commnnti Rexburg, Idaho 83440
BUILDING APPLICATION
Single Family Residence
For Omce Use D1gltahPtans Included Ci? ' ' USB
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DeposittlmounC ' a$500,, ew'Gonst i$ 0Q�Other,pl ;riNew Const.: ` Deposi) Included, q Applicepon' Ye NO
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L. Property Owner
Name: 56kf1 lnlh0VN
Address: tl0 Z C L((b City: [ r State: TO
ieXZip Code: 0340 0
Phone&Type: L480 2AA 5Q7-7 Office Mobile Email: TOHr w+`&>S , b -Z (D
Under Idaho Building Code, a homeowner is allowed to do work on their awn home.
Are you a homeowner doing work on your own home?
Yes (Skip to #4 and complete the Homeowner's Exemption) am a contractor working for the homeowner
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Applicant
Name: Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone & Type: Office Mobile Email:
Contact/Rep. Name: Phone: Email:
3. General Contractor
Name: -I`un,nzrfSd$v'+est Registration #: Exp.:
Address: �' i i �("iz: III r City. _ Yet State: [) Zip Code fi :!J YO
Phone&Type CJI Office MobileEmarT�C,,vt�
Contact/Rep. Name: - c. Phone: %; 'a 4ikd Email:
General Gpn'tractor:quLhorizedSigaaturei' GL Date: yN%4.
4. Project Descriptin
o
Address: 4D 2 S. 4 E OR- Lot #: _ Block #: _ Subdivision:
Type of work:
Check one: New Construction (RetliodeR) Addition* Basement Finish*
*Check all that apply: Framing Mechanical Plumbing Electrical
NOTE: Any sub -contractors involved will need to submit heir ow
signed applications,
*Description of work: P401>,.ca fl�s �rr d' CIA'% rd n'utr QX'At,p &W
*Total cost of project- materials and labor: $qd!: (used to calculate permit fees)
Building Total: I sq. ft. Main: r sq. ft. Basement: Finished Unfinished sq. ft.
Garage sq. ft. Additional Floors: sq, ft.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I 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 ofthe 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, Permitvoidifnot
started within 180 days. Permit void Ifwork stops for 180 days.
Applicant's Name (print): .)bjny) Wjjt� Signature: n/ Date: (D jM /20A
Inspections must be called in before a 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 -(208)372.2344 www.rexburgprg Permit Technician -(208)372.2341 Revised March, 2016