HomeMy WebLinkAboutAPPLICATION - 17-00661 - 459 Rolling Hills Dr - SFR Mechanical OnlyCITY OF
REXBURG ---�---
Ameriras Family Co1111111111ity
For Office Use Permit Number: 17-00661 _____ _ 1.Property O�n�r i"-. ,Name: c.r,c:_, U eJ/t:... ql}e, e_Address: pgs.$ff '1irh r-) JI� Phone: ;Jt> - -5 8
BUILDING APPLICATION Miscellaneous Mechanical Work
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
D M_echanical F�es·Paid
City: l<tXhiAY � . State:-::;:..0.Zip Code: f>3 '-f s/ iJ Email: __________________ _
Under Idaho Building Code, a homeowner is allowed to do work on their own home. Are you a homeowner doing work on your own home? D Yes (Skip to #4 and complete the Homeowner's Exemption) D No, I am working with the homeowner
Mechanical Contractor A1,1�h.9rizeµ Signaµires: �IJ,&.'J2.����:::::!..._ __________ Date: I tJ/4.IJ h 7
A copy of your state registration/license is required to be 011 file. If this is the first time you have done work in the City of Rexburg, please provide
a photo copy of your license. If you are 1111sure if yaur lice11se is 011 file, please check with the Permit Teclmic!tm by calling (208) 372-2341.
'JJ5 -OR-Lot#:_ Block#:'_ Subdivision: _________ _ What type of Property: ·· esidential D Commercial
Costofjob:$/),,IJ.f/ /->'I Description ofwork:_ +ast()..,I i � {y45 t="'LA-rl1ate.6.
4-. Fees: Check all that apply: � Furnace or A/C = $65 D Gas Line = $65 D Water Heater= $65
D Fireplace/Solid Fuel Burning Unit:
o Built-in = $130oFree-standing = $65D 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, I hereby certify that I have read this ap(llicatlon 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 I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized repres entatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on appru�nl 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 orapproval was based. Permit void If not
started within 180 days. Permit void If work stops for 180 days.
Applicant's Name (print): ___________ Signature: ______________ Date: ____ _
Inspections must be called in before 8 AM on the day the Inspection Is requested. Inspection requests called in alter 8 AM will be scheduled for the next business day.
Inspection Hotllne-(208) 372.2344 www.rexburg.org · Permlt Technlcian-(208) 372.2341