HomeMy WebLinkAboutAPPLICATION - 17-00684 - 1161 W 5000 N - MechanicalCITY OF
REXBURG
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America's Family Community
BUILDING PERMIT FORM 110
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Building Safety Department
City of Rexburg
35 North 15C East
Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Mechanical
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Permit Number: ' 6 D ❑ Mechanical Fee Paid
1. Property wner
Name: ry�AIL 4--r/'i 5
it d State: .J Zi Code: Ff30��fG
Address: [✓ S-
I (6 ( .1/'� dy City: p
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?
❑ Yes (Skip to section 3 of this application and complete the Homeowner's Exemption page as well)
�Mo, I am working with the homeowner
2. Mechanical Contractor /
Business: LVr3 I"�2.wb.' 7n f_' UeC,1�.n=, State License#: l4l/C C- 141d Exp.: 5!%&136 Zola
Address: P.Q, l��c 7 City: Qi"L6di5 State:ZipCode:
Phone: 208'- 3.527- 97,76 Email: % 4f P FaVe-*vg—
Contact/Rep. Name: KEUTdx-) Phone: mail:
Mechanical Contractor Authorized Signature: Date:
—
A copy ofyour state registration/license is required to be on file. 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
Address: ( ( 6 ( W 5-7r4'0 N -OR- Lot #: _Block #: _ Subdivision:
Description of work: $i id (,1,4 G p1/ee J
❑ SER Construction: 3 6 S -Z' 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 sq. ft will be charged $325)
❑ Number of Fireplaces:
• Note thatfireplaces are not included in square footage costs and will be charged $65 per inspection.
❑ Hydronic Heating:
• Note that hydronic 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 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. 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-mentionedproperty for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions ofthe 2012 International Code in cases ofany false statement or misrepresentation offact 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.
Applicant's Name (print): jl EN r7 A/ I t 15or4-
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called-KaRer 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341