HomeMy WebLinkAboutAPPLICATION MECHANICAL 2 - 18-00143 - 1585 W 3400 S - Additionnoeyx..eq.
CITY OF
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BUILDING PERMIT FORM 110
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BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use _
Permit Number. IY aUltii M Mechanical Fee Paid
1. ProperN Owner
Name: ii Ht ile �r�L
Address: l�itli -27 .�tli!?_ S: City: -:ail rA State: I Zip Code: /O
Phone: .24 Ad / Z�t6 / 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)
❑ No, I am working with the homeowner
2. Mechanical Contractor 1/
Business:4Lee vuamY 7 51 State License 4: 71/ -%-O-2-xp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: E
Mechanical Contractor Authorized Signmu Ph re Date:
-
A copy ofyour stole registration/license is required inn file. Ifthis is theflrst Mn you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyourl ense is on file, please check with rhe Permit Technician by calling(208)372-2341.
3. Project Description
Address: (,j�� f-✓.�{��`T -OR- Lot #:_ Block #:_Subdivision:
Description ofwork: Mi : 41.,
❑SFRConstrucdon: sq.R.
as Feesfg-nes, construction are charged bysquarefoolage: Up to 1,500 sq.f-=$130♦$65for each additional 1,000sq. It or
portion thereof.
0 Up to 1,500sq.ft = $130. Up to 2,500sq.ft. = $195. Up to 3,500 sq.ft=$260. Up to 4,500sq.ft=$325, etc. fte.0
home with 3,675sq. f . will be charged $325)
❑ Number of Fireplaces:
• Notethalffreplaces are not included in squarefootage casts and will be charged$65 per inspection.
❑ Hydrnnic Heating:
• Note that hydropic hearing is notincluded in squorefoomge costs and will be charged and additional $65 + ($10 x#of
manifolds/zones)
APPLICANTS SIGNATURE CERTIFICATION AND AUTa0N124TION: Under penalty of,moury,lhereby certify that I have read NOT application and sGh Mat the Inkmatlon
herein is rorrert anal woman but any inform#ion which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Countll for the City of
Rexburg shall hettumon aad<arrect Iagm, to comply wish all City regulations and State laws relating to the similar matter of Nis application and hereby authorized
re,rawmance,admCity m an.,.,aIm.basurnennoned property forinspecdom purposes. NOTE: the building official may revoke a permit on approval roved under One
prowls ons few 2012 Imirmxloml Code m rases ofarry Take.... [ of colo plearmanno nffaa in Ne application or on The plans on which the permit or approval was
based Permit sold if not Forms within 180 days. Permitwoid ifworkarops for 180 days.
Applicant's Name (print): -
Date:
Inspections must be called in before 8 AM on One day the mospection is remember. Inspection requests called in after 8 AM will be schcdoled for The near bm iness day.
Inspection Hellin -(208)372.2344 wwwraburgnrg Permit Technician -(208)372.2341
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