HomeMy WebLinkAboutAPPLICATION - 18-00208 - 2130 W 440 S - County Mechanicalc •xxeuac
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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 1Ft East
Rexburg, Idaho 83440
Permit Number: Mdechanlcal Fee Paid
Name: to snuk%\
Address: 5 . -2,00DCity: 2e),C\0tx State: Zip Code: S
Phone: 209-2�(f — 723CI Email: _ � Q 5N A' Ylda�d-rir^S.cavl
Underldaho 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 of this application and complete the Homeowner's Exemption page as well)
❑ No, I am working with the homeowner
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Business: SPrme_. 4.5 Ct "ta State License #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
Mechanical Contractor Authorized Signature: Date:
A copy of your'state, registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the permit Technician by calling (208) 372-2341.
Address: -OR- Lot #: _ Block #: _ Subdivision:
Description of work: 'Fofce. OL,,C v N_ r G_S rCcrJ.i•.vN- ( i�
❑ SFR Consti uction: t) X0 sq. fG
• Feesfurneeb construction are charged bysquarefoomge: Up m 1,500sq.ft=$130+$65foreach additional 1,000sq.R or
portion thereof.
o Up to 1,500sq.ft=$13a Up to 2500 sq.fL=$195. Up to 3,500 sq.ft=$260. Up to 4,500sq.ft=$325, etc (is.a
home with 3,675sq.)t will be charged $325)
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• Note thatffreplares are not included In squarefootage costs and will be charged $65 per inspection.
• Note thathydronlc heating is not included in squarefootage costs and will be charged and additional $65+($10x N of
manifolds/zones)
APPLICANTTSIGNA'mRE,CERnFICATIONANDAO HOMMnON: OMerpermity riparjury,Ihereby certirythst lbeen read this applkaion and anrderan information
hereinbcoNdand IswearNtarw Wormaionwhkbmayhema rbe®venbymeinheanngsberore Ne PlanWngand Zonlim Commbsimor Ne City Coumfiforthe Cityof
Rexburgsha0beamNfulandecrRd 1 axreem mmply with all Cay regulanorts and state bar ridem tae the robed matter roads application and hereby authorized
repreae ratheas afthe City he enrer upon the aboyernerakned property for mspecnpns purposes. NOTE: The bWldiag ohtcial may rewkea permit on approval issued antler Ne
p.WW.dffie20121ntermtlo®1Cadeinsawsofa,PlxemmmemormNrepmemanonof NadN eapplicationoronmeplansonwhichthepermnarapprmmlwn
based. Permnwid anM smmed wtthin 180 days. FermRwiddworksNpsfor100days.
Applicant's Name
Inspection
Date: ��— lO
Scheduled for are next bushine day.
Permit Technkien-(200)3722341