HomeMy WebLinkAboutAPPLICATION - 16-00465 - 630 Sunflower Rd - Gas Water HeaterC1 TY Of
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BUILDING APPLICATION
Nilechanical
City of Rexburg
3 5 North 1st East
Rexburg, Idaho 83440
0
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eri-nift Number-, Ptelrmit,vVie: 0 New0 Remodel 0 AdWition Basement Finish
Fees Paid- 0 Yes 0 NO.,
P, ope Ownet
Name:_LQ65-�t Pf*Ats
Address: Ci ty: State:
Phone &Type: 11V`Ln -511k —0 Office obile Email: 11.%-1 V% -
Under Idaho Building Code, a homeowner is allowed to do work on their own home
Zip '"ode: b-3
Are you a homeowner doing work on your own home? 0 Yes (Skip to #3 and complete the Homeowner's Exemption page)
N<o: I am a contractor working for the homeowner C No- This property is da Multi -family Residence or Commercial Property,
NOTE, .Any (,,oT-it--t,act�ors/sLtb-conti'actf).rs involvc-,d will need to su'Drnittlh�-,ir avk73) sigune-d apph-lations.
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2. ;Nilecha-niccal Corltra.f.-tor
S tExp..
Name: lk Registration : to
iiLAL I -.L,(,- #
Address: City: t State: I Z -JP Code:
Phone & Type:IDR) Ir lym
LI? 13 Office M-iVlobile Email:
Contact/Rep. Name: Phone: t Email:' Ji., 61 VV, COWA
M0 is l Con.tr.ctor Authorized Signature:
Date C(01"Dj I t,
Project Descriptiotl
Address: o- 0�4VAzi.- -OR- Lot #: __Block #: Subdivision:
Check one: PoSiffigle-family Residence 0 Multi -family Residence 0 Commercial
Check one: 01 New Construction* 0 Remodel 0 Addition . 173 Basement Finish
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the infon-nation herein
is correct and I swear that any information which may hereafter be given by the 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 reguiations and State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above -m enti o tied 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 ifDOt
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): V- Signature:
Date:
Inspections must be called in before 8 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,.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016