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HomeMy WebLinkAboutAPPLICATION - 18-00379-18-00385 - 17 S 4th W - Snellgrove Townhomes - #301-#307CITY OF REXBURG America's Family Community BUILDING PERMIT FORM 1�0 Updated 10/2016 BUILDING PERMIT APPLICATION New Single Family Residence Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: CZ395 Zoning: /4fXC.Of U6 -e Application Fee Paid: ❑ $500 1. Property Owner ( y Name: �} Address: 0 -e(G `�I'o � City: �Z16,13 w State: Zip Code: Phone: 7C, '" ® � ( Email: is f L S e -G C 4F �1 Le4&; C. 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 #4 and complete the Homeowner's Exemption) No, I am working with the homeowner 2. Applicant Name: _ 5kbt Role: (Owner, Tenant, Contractor, etc.) Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: 4'-1 3. General Contractor Name: l�D �7 l�Gi/ 0?, -eV Registration#: s— Exp.: Lo ?I ���"�� Address: Z U /%/ rf�, City, State: �� Zip Code:1� r c 1 Phone: Email: ren S.r,t�=�'/' cy x cK04,rtu,..__ Contact/Rep. Name: 1�1 � t/C_L! PhoneZ07' X7--62 : General Contractor Authorized Signature: �� Date: 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 photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 4. Project Description (/ 9 �©1`%6 7 P(- � f 7� Address: M � df) 7 -OR- Lot #: _ Block #: _ Subdivision: < Project Description: • Square Feet: Building Total. ' ' sq. ft. • # of Water Meters: Water Meter Size: o Main Floor: ��O sq. ft. 0 Fireplace(s) Being Installed? ❑ Yes ❑ No o Additional Floors: `KZ0 sq. ft. Hydronic Heating Being Installed? ❑ Yes ❑ No o Basement: Finished sq. ft. Building Permit fees for new homes are charged based on square Unfini5 edSq. ft. �76 0 footage and the City's estimated valuation. For details on how fees o Garage _ sq. ft. D _ are calculated, contact the Building Department. There will also be • Estimated Total Cost: $ w� a plan review fee totaling 10% of the building permit fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by mein 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 on approval issued under the provisions of the 2012 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. Permi voi if not started�ythin 180 da s. Permit void if work stops for 180 days. Applicant's Name (print): �/��- Signature: Date: // I Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be sc eduled for the next business day. Inspection Hotline — (208) 372.2344 www.rexburg.org Permit Technician — (208) 372.2341