HomeMy WebLinkAboutAPPLICATION - 17-00452 - 1128 Green Willow Dr - Wheel Chair RampO�µNXBURC
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C I TY OF
REXBURG
America! Farn ly t.omniunity
BUILDING PERMIT FORM 1OZ
ByJnrcd 222017
BUILDING APPLICATION
Single Family Residence Addition
Building Safety Department
City of Rexburg
35 North 1Bt East
Rexburg, Idaho 83440
For Office Use
Permit Number: ck) k5 d- Zoning: ` Application Fee Paid: $100
1. Property Owner
Name: zlqf
Address: I I 8 G�e� 0;1(0L,-1 hr City: State: T A Zip Code:
Phone:(3a3) 5-29 - 7I17 Email: d'P-r4 (Qa i c y (a r gh, ca si n e}
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are youa ho eowner doing work on your own home?
Yes (Skip to section 4 of this application and complete the Homeowner's Exemption page as well)
❑ 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 li: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date:
A copy 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.
h. Project Description l^�
Address: 1(Z? Cre2rn W,� oc"7 t^ '
Project Description: 0 �,e ��� r ✓"0. —14
• Square Feet of Addition: sq. ft.
• Estimated Total Cost: $ goo
• Fireplace(s) Being Installed? ❑ Yes No
Building Permit fees for new homes 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/ee totaling 10% of the building permit fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION. Under penalty of periury, I he, certify that I have read this application and state that the information herein
is collect and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission as 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 of the 2012
International Code in cases of any false statement of misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void !fact
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): ttw So Signature: Date: �-' " %
Inspections must be called in belore 8 A 7 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) 3 72.2 344 www.rexbu rg.m g Permit Technician - (208) 372.2341
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