HomeMy WebLinkAboutAPPLICATION - 17-00132 - 555 Golden Willow Dr - Detached GarageQgexaupc
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R URGBUILDING PERMIT FORM 404
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BUILDING APPLICATION
Residential Accessory Structure
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: 17-00122- Zoning: Application Fee Paid: D $100
1. Property, wner
Name: V �C�oI'`K l _
Address: r�; �irijClPi2 i 11W t✓ City: PC� _-State: Jh Zip Code:
Phone: 7JF/ b?D— �_1$60 Email: 1A WkC_'Gi wer L'oy&
Under Idaho Building Code, a homeowner is allowed to do work on their own home.11
Are you a homeowner doing work on your own home?
P'�es (Skip to #4 and complete the Homeowner's Exemption)
D No, I am a contractor working for the homeowner
2. Applicant
Name: Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name:
3. General Contractor
Name: Registration #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature:; Date:
Acopy 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. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Structures less than 200 square feet do not need a building permit Structures 200 square feet or larger need a building permit and
must adhere to these back rules he zone in which they are built
Address: �� ' Or��. �� i1f D
Project Description: ' � 1i) G
• Estimated Total Cost: $ b C' • Square Feet of Addition: 90b sq. ft.
• Type of structure:
D Deck D Garage/Car port D Shed/Shop D Other: Explain �)1 t I UO tLZ �r7lZJP&
• Check All Included in Scope of Work: {
D Mechanical Work Cost: D Electrical Work Cost: $� El Plumbing Work Cost: $ LV
Note: Any contractors involved will need to fill out their respective application.
Building Permit fees for accessory structures are charged based on square footage and the City's estimated valuation. For details on how fees are calculated,
contact the Building Department. There will also be a plan review fee totaling 10916 of the building permit fee.
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 me in 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 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. �/ 9
Applicant's Name (print): -kys d v,-'d_r Signature: l�.i m E4 V_V ls' Date: �
Inspections must be called in before 8 M on the day the inspection is requested. Inspection requests called in after 8 AM will he scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341
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