HomeMy WebLinkAboutAPPLICATION - 17-00632 - 2900 W 5200 S - Gas Line6� gP X B �kG
4 c "Y o rBuilding Safety Department
� O
REXB1 Bi1ILDING PERMIT FARM 410 City of Rexburg
----- uPaaeeaia�zots 35 North ��t East
Amad"1uxs brsnlil 'Ci,m t-ty
Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Mechanical Work
For Offs o --
Pert„ it l tllil�71':
Cala
1. Prope't't> 04t'tler
Dame: 1
Address: _
Phone: (� -` / _ y� �/ _ City: State:L Gip Code: r
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 -9 and complete the Homeowner's Exemption)
®'No, I am working with the homeowner
2, Mechanical Contractor
Underldaho, (Building Code, a registered contractor mustdo the workfor a Commercial Building,
Business: fif�r�lS l 1)LLIM
State License #:l� Address: L(' '�S W§ C�f,n - 1 Exp.:
Cit}': S>t State: J__Zip Code,e?JVVS-
Email:
Contact/Rep. Name:
�caa CUrtractar;trthaltzeci Siglature. r
A cnpy nryuur state reg rcrri/liar.Se is requrrecl to be on ile• If this is the fast tlrn rtu haare done w in the City of Rexbur , please ovid
a photo copy ofyour license. ifyou are unsure rfyoul' license is on file, please cher.It with the Permit 3'echnician by calling (208) 372 '1341
3. Project Description
Address: 7:QgQ 0 -OR- Lot #: _ Block #: _ Subdivision:
What type of Property: ❑ Residential ®'Commercial
Cost of job: $ 5,000 00- - Q
Description of work: f irm 7S ;yrr A. i ._
4. lees: Check all that apply:
❑ Furnace or A/C = $65 ❑ Fireplace/Solid Fuel Burning Unit:
13�Gas Line = $65 o Built-in = $130
7 Water Heater = $6S o Free-standin
g=$65
❑ Miscellaneous/Requested Inspection = $65
Inspection fees can be bundled upon request. Re -inspect fees will be enforced if inspection requests exceed fee totals.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I have read this application and state that the information herein
is correct and 1 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. I agree to comply withal] City regulations and State laws relating to the subject matter of this application and herebyauthoriaed representatives of the
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. Permitvoid Sf not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): C' Ut t Signature:
r_Date: � �/7
4rGrZ[Sf �cGvn�S �kte—
Inspe tions must be called in before 8 AM on the day the inspection is requested, laspection 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