HomeMy WebLinkAboutAPPLICATION - 16-00611 - 436 Maple Dr - Remodel0 °A pAXBUgC
�� r° CITY OF
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REXBURG
Amerfc6 Family Community
BUILDING APPLICATION
Single Family Residence
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Digital Plans Included: ❑ CD Cl USB Cl Dropbox ❑ Not Included
Permit Number: '0/(
Permit Type: ❑New ❑Remodel ❑Addition ❑Basement Finish
Deposit Amount: 13 $500 New Const. ❑ $100 Other than New Const Deposit Included with Application: []Yes ❑ No
1. Propel: ty Owner
Name
Address: U
.City: hk=&n State: -IT—) ZipCOde,.93*"�
Phone & Type:
❑ Office ❑ Mobile 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) O No, I am a contractor working for the homeowner
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. APp. t
_ i
Name: -ilk1�
Role: (Owner, Tenant, Contractor etc.)
Address: R KA ts) "Jg C2 U
City: b State: � Zip Code
Phone & Type:7F%rf,741"AAU_-
Cl Office ❑ Mobile Email:
Contact/Rep. Name -.727A& r-8' —
Phone:76% >! � t Email:
3. Gen
Name:�A /A
Registration #:T_�l�'� 4/1 '8
Address: lg26 UL) a`j`
City: State: Zip Codelrj �
Phone & Type:
Cl Office ❑ Mobile Email:
Contact/Rep. Name:
Phone: Email:
'General Contractor Authorized Signature:;
Date:
4. ProjectDescriptiQn�V*-
Address: BA� VW} %:: r
-OR- Lot #: _ Block #: _ Subdivision:
Type of work:
Check one: ❑ New Construction -Remodel*
❑ Addition* ❑ Basement Finish*
*Check all that apply: ❑ Framing ❑ Mechanical
❑ Plumbing ❑ Electrical
NOTE: Any sub -contractors involy will need to submit their own signed applications. -
`a
*Description of work: �k
*Total cost of project - materials and labor: $
(used to calculate permit fees)
Building Total: sq. ft Main:
sq. ft Basement: ❑ Finished ❑ Unfinished sq. ft.
Garage sq. ft. Additional Floors:
sq. ft.
29
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information herein
is correct and 1 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. 1 agree to comply with all City reguladam 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 permiton approval issued under the provisions ofthe 2012
International Code in cases ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit voidifnot
started within 180 days. Permit void ifworkstops for lJdays.
Applicants Name (print): v S
ignature_�1 Date:—+�
Inspections most be called in before 8 AM on the day the inspection is requested. Inspection requests called in after SAM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016