HomeMy WebLinkAboutAPPLICATION MECHANICAL - 18-00038 - 306 S 3rd W - Relocated Duplexoa"""^�,, CITY o N Building Safety Department
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7 '�G' BUILDING PERMIT FORM City of Rexburg
9,10
a,aunm,^^=f=na= 35 North 150 East
Ams m`�y�mmmiy Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Mechanical Work
For Office Use
Permit Number: ❑ Mechanical Fees Paid
1. Property Owner
Name: S,d,m ,Slw.laae�
Address: 3///J 3�5 City: 6411c, state: ;,Zip Code: >�3
Phone: iJlB)-7j R'/ Email:
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 section 4 of this application and complete the Homeowner's Exemption page as well)
No, I am working with the homeowner
2. Mechanical Contractor
Underldaho Building Code, a registered Contractor must do the work far a Commercial Building.
Business: � mau,,� 1l1I1/GC NraT n_ 1 Air /:.vi'lfdx%u State License #: low(o Exp.: 14AM
Address: fIiGL F Ferriiaa AOL City: . w6L /SIA State: ZjZ Zip Code: 044/
Phone: 9aa 4/11200 Email: vsr/ Ifii sI%. (' aN
Contact/Rep. Name: ane: Email:
Mechanical Contracul Authorised Signature: Date: 95 g
A Cray ofyour state registration/licenser, required tab onIe. this is theffrst uneven have done work in the City of Rexburg, please provide
a photo copy ofyour license Ifyou are unsure ifyour license is on/ile, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: 3///i/ 7,rair5 -OR- Lot #:_ Block #:_Subdivision:
What type of Property:. esidenfial ❑Commercial
Cast ofjob:$ r 00
Description ofwork:
4. Fees: Check all that apply:
Furnace or A/C =$65 ❑ Fireplace/Solid Fuel Burning Unit:
Gas Line et $65 o Built-in = $130
❑ Water Heater=$65 o Free-standing=$65
❑ Miscellaneous/Requested Inspection=$65
inspacaonfees can be bundled upon request Re-inspeRfees will be enforced ifinspecaon requests exceed fee total,
APPLICANTESIGNATORE,CERTIFICATION AND AUTHORIZATION: Underpemlry0lperjury,I berebyrertify Nall M1ave read tM1lc appllmtlon anti stab Na[Nelnlomunoo hefein
LsmrrMand I ¢wear that any Information which may hereafter be given by mein warm, before the Planning and tuning Commission or the Clry Council for the C'ryof Rwbwg
Nall be tmthfid and mmttL Ia,mia comply who allCItyragulaticns and State laws neatingrome subleflm derof Nis application and hereby au uonaed representativecof Ne
Clry m enter upon are above-mentioned property for morpro tlmu purpmes. NOTE'. The hudding official may revolve permit an approval issued under the provisions ofine 2012
Intermarried Code In mars many Use statement or miuepresentatlon of fact In the application or on Ne plans on which the permit or approod was based. Penult void Ifml
maned wenn 180 days. Permit void lwork stops for 180 days, /),
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Applicant's Name (print): tns signature Date: 23 t/
Inspections murtbe called in before DAM on medaythe inspectun is rearward. lnspMlon requestsmlled in after 8 AM will be scheduled for the nonearderes day.
Incpaeon Hotline -(208) 372.23. w vreame buBofg Pere irTerhadclan-(208) 3732341
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