HomeMy WebLinkAboutAPPLICATION - 17-00538 - 387 Airport Rd #32 - Exhaust Fan048yxauRC
R; a _ CITY OF
REXBIMG BUILDING PERMIT FORM 410
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Atneriw3 Family Community
BUILDING APPLICATION
Miscellaneous Mechanical Work
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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1. Propett�r Owner
Name:�6 bw-A� �`�'
-
Address: 2J3 -7di 30 City: 0 7 _ VGA State: Zip Code:
Phone: 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 section 4 of this application and complete the Homeowner's Exemption page as well)
19/No, l am working with the homeowner
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor mustdo the work for a Commercial Building.
Business: it V1to afi iY4 State License #: _O 1 Exp.:
Address: q E aui A) St e: l Zi Code: ALJ
Phone: -7 _ ai : �-
Contact/Rep. Name: Phone: Z'g- 74S-MAEmail:
Mechanical Contractor Authorized Signature: Date:
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A copy ofyourstate registration/license is required to be on file. If this is the first timeyou 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.
3. Project Description
Address bn pAymf+ 2A 3Q -OR- Lot #: _ Block #: _ Subdivision:
What type of Property: 63'(esidential ❑ Commercial
Cost of job: $
Description of work: is 1
4. Fees: Check all that apply:
❑ Furnace or A/C = $65 ❑ Fireplace/Solid Fuel Burning Unit:
❑ Gas Line = $65 0 Built-in = $130
❑ Water Heater = $65 0 Free-standing = $65
W Miscellaneous/Requested Inspection= $65
Inspection fees can be bundled upon request Re-inspectfees will be enforced if inspection requests exceed fee totals.
APPLICANT'S SIGNATURE, C
is correct and I swear that m
shall be truthful and correct
City to enter upon the above
International Code in cases r
started within IRO days. Per
Applicant's Name
AND AUTHORIZATION: Underpenalty of pelury, I hereh certify that l have read this application and state that the information herein
vhich may hereafter be given by mein hearings bef.re [h Planning and Zo nine Commission or the City Council for the City of Rexburg
ply with all City regulations and State laws relating to the ubject matter of this application and hereby authorized representatives of the
pertyfirinspectionspurposes. NOTE: Thebaildmgoff al may revoke a permit on approval issued under the provisions of the 2012
anent or misrepresentation of fact in the applicatio�Oro the plansonwhic mit.,approval was based. Permitvoldifnot
c stops for 180 days. \\
Signature:
Date: 4Y-31-j7�'
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 - [2013] 372.2344 www.rexburg.org Permit Technician - (208) 372.2341