HomeMy WebLinkAboutAPPLICATION - 17-00615 - Summerfield - Water Meterd'3 �,,'Y7�5°' �a4�s
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CITY OF Building Safety Department
City of Rexburg
G BUILDING PERMIT FORM 430
OwaP^a�=^:i�^�y 35 North 1st East
AmericaI FamfyCommon/fy Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Plumbing Work
For Office Use /
Permit Number: /7-aP_J ❑ Plumbing Fees Paid
1. Property Owner C D I� �u� y
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tAM1r O 1L tes*/S n j��
Name: J
Address: )TDO NO I, ZDO &^s City: 14M060% State: uT Zip Code: 89347
Phone: 415- 740 - .2983 Email: 1440ey . II & Asr" • C-001
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)
Cl No, 1 am working with the homeowner
2. Plumbing Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: >+4,faXf onz StateLicense#: .R C f -S L 7� Exp.: /' 'V le
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Address: St.Z kl I •e o�»4
ngt �et� City: 8 jot I% S State:Zip Code: iJr W '2 -
Phone:
Phone: O-6.?T LR01 Email: _; s)�:42
Contact/Rep. Name: Phone: ROa'- i 2f ail:
Plumbing Contractor Authorized Signature: Date r
A copy ofyour state registration/license is required to bean . If this is the first time you have done work in the City of Rexburg, please provide
a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description JJ p
Address: .21 W..,f -OR- Lot #: 7 Block #: 10 Subdivision: fetnherfi e
What typeofProper•Uesidential XCommercial
Cost of job: $ 213 3 y- 60' ^ I 41.4 30,
Description ofwork:
4. Fees: Check all that apply:
❑ as ' - ❑ Hydronic Hea ' + ($10 x # of
❑ Water Heater = $65 0 ds/zones) = $
❑ Sewer Line = $65 ❑ Miscel an Chested inspection = $65
Water Line = ❑ Sewer Turnaround (septic to •t3c= $65
Lawn Sprin ow device = $65 Inspection fees can be bundled upon request Re -inspect fees�will be
ay ems = enforced if inspection requests exceed fee totals.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, 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 be 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. 1 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? permit on approval issued under the provisions of the 2012
International Code in cases ofany 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 if work stops for 180 days. or
Applicant's Name (print): Ilan Cud`s eh Signature:Date:' fl 7
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 - (2 08) 37 2.2 341