HomeMy WebLinkAboutAPPLICATION - 17-00708 - 451 E 2nd S - Furnace Replacement0
CITY OF
— trycla. RG
Americas Family Community
BUILDING PERMIT FORM 410
UNAld 10/9016
BUILDING APPLICATION
Miscellaneous Mechanical Work
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fees Paid
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Name: S ' 'I-Y1Wyyl llrl y1�11
Address:n�Q City: State: Zip Code:
Phone: abs_ �3 NOS Emai 7YZ I
Under Idaho Building Code, a homeowner is allowed to do work on their own home, I
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #4 and complete the Homeowner's Exemption)
o, l am working with the homeowner
2. Mec apical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
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State License #: Exp.:
Business:elfr1
Address: rt(i Q City: State: Zip Code: U�
Phone: IE W'
Contact/Rep. Name: Phone: %B- 748p Wd Email:
Mechanical Contractor Authorized Signature:��AJ� a AV��M\ Date: I
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 Descriptio
Description
Address: q5l E OR- Lot #: _ Block #: _ Subdivision:
What type of Property: ❑ Residential ❑ Commercial
Cost of job:$LI Qco
Description of work:
4. Fees: Check all that apply:
Furnace or A/C = $65 ❑ Fireplace/Solid Fuel Burning Unit:
❑ Gas Line = $65 o Built-in = $130
❑ Water Heater = $65 o Free-standing = $65
❑ Miscellaneous/Requested Inspection= $65
Inspection fees can be bundled upon request Re -inspect fees will be enforced if inspection requests exceed fee totals.
APPWCANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l 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 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 a permit an approval Issued under the provisions of the 2012
'OOMO\ 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
startedwithin 180 days. Permit void ifwork stops for 180 days.
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Applicant's Name (print): C�pya ff; 1�1I WA ignature: Z_\ gg k,�, 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