HomeMy WebLinkAboutAPPLICATION MECHANICAL - 18-00026 - 430 S 3rd W - Exhaust Fanso4esze cep e
CITY ° P Building Safety Department
° REXBURG
BUILDING PERMIT FORM 410 City of Rexburg
Ama.�rycnm�,nnxy wm.vtna' 35 North In East
Rexburg Idaho 83440
BUILDING APPLICATION
Miscellaneous Mechanical Work
1. Pro)
Name:
Phone a:211R mil r— R city`k Qxl�—state: —zip Code: x�1440•
Underldaho Building Coda; a homeowner is of/owed to do wok and 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)
Under Idaho Building Coder a registered contractor must do the workfor a Commercial Building.
Address; _'%�['%�I �. �I��N `J
Phone: City:
Contact/Rep. Name: \� V1fp r G(jnn
Mechanical -ContlacmrAut horized Si r�
gequire: Date:
A copy ofyyofyoelicem a tfyouareaisrequiredtobeon is I if1a aim chatameyau have done work in the City 0f Rexburg, please pmvia
aphotocopy ofyourl(cense. tfyou are unsure ifyow licenseaon/Ile please chek You
thePermit h'
3 Project D by /ting (208) 372-2341.
Address: 92T% ' 3 -DR- Lot ft; _ Block #: _ Subdivision:
What type of Property: ❑ Residential O'Eommercial
Cost ofjob: $24ns 0 1-
Description ofwork;_ �XyLGilAc3} -"KT l�S
4. Fees: Check all that apply:
❑ Furrlaceor A/C=$65 ❑ Fireplace/Solid Fuel Burning Unit:❑ Gas Line=$65 o Built-in=$130
❑ Water Heater=$65 o Free-standing=$65
❑ Miscellaneous/Requestedlnspection=$65
/nspettion/ees can be bund/ed upon rcquesC Re-lnspett f¢¢s wll/be en/orced Ifiupection rcquestr exceed fee tom/s.
APPIICANTS SIGNATUPB. CER11PIWT111 All All,,,,,,. Un4e1pemit'.1peljurg l hereby Carry, eat have reed NkepPll®twnand.gah the[Meln(armatlon M1ereln
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APPlicanYs Name (print): Signature: Date:
ingpenleNmn#be eelletl In before BqM onmetlayme I�ectlon ie requeAM InryxGonrryueab ppei In anm¢AMwIN beschedulM for th nder-(onsday.
Lupxyon Xatlme-[208]3]3.2344
www.rmburg.org Perml[Teohnitlen_(208)3I21341