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HomeMy WebLinkAboutAPPLICATION - 17-00543 - 6505 W 3800 S - New SFR Mech0.>XaYR h,0 CITY OF V4 ° REXBj.TIZG cW AmeNm3 Asmiiy Cortnnuniry BUILDING PERMIT FORM 110 npdaud10/3016 BUILDING APPLICATION New SFR Mechanical Building Safety Department City of Rexburg 35 North let East Rexburg, Idaho 83440 For Office Use Permit Number: ❑ Mechanical Foe Paid 1. Property Owner Name:-�-}6'�� Y"t° Address: JhIJ 2JI City:/a) �� State: 110_ Zip Code: 8-alg24 L Phone: 5_,K-2114 Email::"c/''t-Q�Ca'!}zlnylar�� •r�• 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) tTNo, l am working with the homeowner 2. Mechanical Contractor r (((� Business: t- �aot�J I" b _ State License #: ©� Z 5S 2 Exp.: �✓ }i `$ Address: o City: Stat : �_ Zip Code: Phone: `a '2 Em jl: © �' drf' as ray ContactJRep. Name: Cht-�• t Phone: Z Email:of4 Mechanical Contractor Authorized Signature: A copy of your slate registration/license is required to be on file. If this is thlflrsttimeyou have done work In the City, ofRexburg, please provide a photo copy ofyour license. Ifyou are Unsure tfyour license Is on f ie, please check with the PennftTechnician by tailing (208) 372.2341. 3. Project Description 1 p Address: (oSbS w ?I td o0 S. kCyb f`Y .OR- Lot #: _Block #: _Subdivision: Description of work: V W .xr j-% ry t ❑ SPR Construction: )3 L I sq. ft. a Feesfornew construction are charged bysquarefootage: Up to 1,500sq.ft. = $130 + $65for 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.R. = $260. Up to 4,500 sq. ft. = $325, etc. (le. a hodne with 3,675 sq. ft. will be charged $325) • Number of Fireplaces: *Note thatffreplaces are not included in squarefoomse costs and will be charged $65 per Inspection. ❑ Hydronic Heating: _46111- I Note that hydronlc heating Is not included In square footage costs and will be charged and additional $65 + ($10 x # of manifolds/zones) APPLICANT'S SIGNAI URE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, i hereby reruns that l have read this application and state that the infarmatlon herein Is correct and 1 swear that any Informatlon which may hereafter be given by me In hearings before the Planning and 7aningf Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and Stale 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 an approval Issued under the provisions ofthe 2012 International Code In cases ninny 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. Applicant's Name (print): Tf( eVc?IS0`n Signature: :3"1 Y"'-� Date: 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 bust vess day. Inspection floulue- (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341