HomeMy WebLinkAboutAPPLICATION - 16-00307 - 343 Talon Dr - Basement FinishCITY OF
RMURG
America's 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 ❑ USB ❑ Dropbox ❑ Not Included
Permit Number: ri I cia Permit Type: ❑ New ❑ Remodel ❑ Addition RBasement Finish
Deposit Amount: O $500 New Const O $100 Other than New Const Deposit Included with Application: ❑ Yes []No
1. Property Owner
Name: L/rt�T�3 C/-tA,trDLc�r
Address: -3y3 744.01V City: __/k* Pt~'7 State: /--/!N Zip Code:
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) No, 1 am a contractor working for the homeowner
NOTE: Any contractors/subcontractors involved will need to submit their own signed applications.
2. Applicant
Name: Role: (Owner, Tenant, Contractor, etc.)
Address: 29 3- zaarj /n/ City: &C74,12L12e-L2 State: 10 Zip Code: L vie
Phone &Type: ? 3 F - 91T9 ❑ Office O Mobile Email:
Contact/Rep. Name: J&^r>,4iYydu hl_tt "e: 2Pp-fLS2 iEinail:
3. General Contractor
Name: Registration #: 4rG 270-60 Exp.:
Address: City: State: Zip Code:
Phone & Type: ❑ Office ❑ Mobile Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date:
4. Project Description
Address: -OR- Lot #: Block #: _ Subdivision:
Type of work:
Check one: ❑ New Construction ❑ Remodel* ❑ Addition* dLBasement Finish*
*Check all that apply: ❑ Framing ❑ Mechanical ❑ Plumbing ❑ Electrical
NOTE: Any sub -contractors involved will need to submit theirown signed applications.
*Description of work: / i.trr i2rrH 6'77_
*Total cost of project - mate -ials and labo : $ (used to calculate permit fees)
Building Total: _ sq. ft. Main: sq. ft. Basement: ❑ Finished ❑ Unfinished sq. fL
Garage sq. ft. Additional Floors: sq. ft.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that i 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 regulations and State laws relating to the subject matter of this application and hereby authorized representatives ofthe
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 ifwork stops for 180 days.
Applicants Name(p ' Signature: J-o.,,y,� ���%�r� Date:
Inspectionsm the called.. be fore 8 AAMan the day theinspection 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