HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00413 - 636 Centennial Loop - SFRPage 4 o
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Building Safety Department
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V 13o City of Rexburg
-� T� y BUILDING PERMIT FORM
l�G 35 North 15t East
Ar1lrTi,iA hil r,i�r Coml711111ity Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Plumbing
For Office Use
Permit Number: ❑ Plumbing Fee Paid
1. PI uilerty Owner
Name: Shan Nit7le4
Address: 1825 Mid Ave ------City: Ammon __ State: �D —Zip Code: _83406
Phone: 203346-0846_ _ Email:, be t'@Oc'qPPerereekhcmesidaho.aom
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 #:3 and complete the Homeowner's Exemption)
EkNo, I am working with the homeowner
Z. Plumbing Contractor 06430117
017991
Business: Tate's PI m In Repair,LLC _ State License #: _ _Exp•:
Address: 275 Chatham Dr _ — City: Idaho Falls _ State:. _ Zip Code: 33401
Phone: ?Da��a,52 ai 92,9 _ Email: tatesplumbing@gmall.com
Contact/ Rep. Name: Samuel Cody Tate Phone: 203-521-8929. Email: tates luum_ i mail.o0m
Plumbing Contractor Authorized Signature: _ Date:
—
A copy of your state registration/license is rewired to be on file. If this is the first time you have done work in the City of Rexburg, please provide
a photo copyofyour license Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: 636 Centennial u -OR- Lot #: Block #: _ Subdivision:
Description of work: New Consttirction
[ANe1v SFR Cu nstrurtiorl-`3060 sq. ft.
• Fees for new construction are charged by square footage: Up to 1,500 sq. ft = $130 + 565 for each additional 1,000 sq. ft. or portion
thereof.
o Up to 1,500 sq. ft. _ $130. Up to 2,500 sq. ft = $195. Up to 3,500 sq. ft = $260. Up to 4,500 sq, ft = $325, etc. (ie. a
home with 3,675 sq, ft. will be charged $325)
❑ Ilvdronic (In -floor) heating: ❑ Yes Q No
• Note that hydronic heating is not included in square footage costs and will be charged $65 + ($10 x # of manifolds/zones).
APPLICANTS SIGNATURE,CERTIFICATION AND AUTHORIZATION: Under penaltyofperjury, I hereby certify that I have read this application and state that the Information herein
Is correct and I v%vear that anyinfo rmat ion which may hereafter be given lyv me In hearings before the Planning and Zoning Commission or the City Cou net] forthe City of Rexburg
shall be truthfuland correct I agree tocomplytvlth all City regulations and State lass relatingtothesubjectmatter ofthls applicationand hereby authorized representatives ofthe
Cltyto enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe2012
International Code in cases of any false statement or misrepresentation offact in the application or on the plans on which the permit or approval was base& Permit void if not
started%%ithin180days. Permit void if work stops for 180 days_
Applicant's Name (print): ______Signature,.— Date:
7/20/2(
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