HomeMy WebLinkAboutAPPLICATION - 17-00578 - 8610 E Hwy 33 - New SFR Mechanical OnlyCITY OF
RMURG
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America's Family Community
BUILDING PERMIT FORM 110
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BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: �� `(�O�Zg D Mechanical Fee Paid
1. Property 0 er
Name:
Address: 0 ,x.33 City: q 6 State: Zip Code: O-") %y
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?
D Yes (Skip to section 3 of this application and complete the Homeowner's Exemption page as well)
.O�No, I am working with the homeowner
2. Mechanicalstor
Business: 'LG LLC, State License #: VG' G' a d U Exp.:
Address: City: State: Zip Code:y�
Phone: 3 Email: I St'itAMly (2
Contact/ p. Name: Gtr Phone: V Email: V SG +S L
Mechanical Contractor Authorized Signature: — R"I o Date:
A copy ofyour state registration/license is required to be on filei. 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 DescriR4�p� ''
Address: jj c OR- Lot #: _Block #: _Subdivision:
Description of work: &r 425 +l a ce
D SFR Construction: � Sdd sq. ft.
Fees for new construction are charged by square footage: Up to 1,500 sq. ft. = $130 +$65 for each additional 1,000 sq. ft or
portion thereof.
0 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. (i.e. a
home with 3,675 ft, wil be charged $325)
❑ Number of Fireplaces: I—
Note thatfireplaces are not included in square footage costs and will be charged $65 per inspection.
D Hydronic Heating:
Note that hydropic heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of
manifolds/zones)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information
herein is correct and I swear that any information which may hereafter he given by me in hearings before the Planning and Zoning Commission or 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 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 100days. Permit void if work stops for 180 days.
Applicant's Name (print): r� ignature: 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 business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341