HomeMy WebLinkAboutAPPLICATION PLUMBING - 18-00635 - 40 Valley View Dr - New SFRU
C I T Y O E
REXBURG
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Americas Family Community
BUILDING PERMIT FORM 1�►O
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BUILDING APPLICATION
New SFR Plumbing
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office I;Se
Permit Number: ❑ Plumbing Fee Paid
1. prop crty )y )I(']-
Name:
ltrrName: - mr YKorY
Address: City: State: rP Zip Code: yro
Phone: / --00e— til 70 "a.T-07 Email: _ r/�� i SSS I ar38' ( r --&—
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 ip to #3 and complete the Homeowner's Exemption)
0,1 am working with the homeowner
2. Plumbing Contractor
Busines R State License#:0V45g3 Exp,: �-3l
Address: -� .�, � City s r State: Zip Cade:
Phone: O - — Email f if C�
Contact/Rep. Name: / P/hne:6p - 1 Email:
Plumbing Contractor Authorized Signature: Y Date.
.? copy of yourstate req istr•atinn/license is required to be on file. 11'14s is the first arae you have dotle woi k in the City of Rexhurg, please provide
a photo toffy of your license. Il you are unsure if your license is on file, please check with the Permit Technician by catling (208) 372.2341.
3.
pro -c Descr,�" 1�ti°I
Address: �v V u`� l`^✓r -OR-,, ff Lot #: Block #: _ Subdivision: V �7
Descri -ion of work: w -t ()'+Z /� —2
etix• 5FR Construction 24 5CCI sq. ft, (F-^ t–- -,5k -ed Ka
• Fees for new construction are charged by square footage: Up to 1,500 sq, ft. = $130 + $65 for each additional 1,000 sq.ft orportion
thereof.
o Up to 1,500 sq. ft. _ $130. Up to 2,500 sq. ft = $195, Up to 3,500 sq, ft = $260. Up to 4,500 sq, ft = $325, etc. (i.e. a
home with 3,675 sq.�ft. will be harped $325)
❑ fivdr'oric (In-fioor) Hfvatirlg: ❑ Yes;2
• Note that hydronic heating is not included in square footage costs and will be charged $65 + ($10 x # of manifolds/zones).
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the information herein
is correct and I swear that any information which may hereafter be given by me in hearings befure the Planning a rid Zoning Commission or the City Council for the City or Rexburg
shall be truthful and correct. 1 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 pians on which the permit orapproval was based. Permit void if not
started within 180 days. Permirvoid rfwork stops for 180 days.
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Applicant's Name (print): % Signature. Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after SAM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
TYPE L knot Issued
PLS CONTRACTOR 024593 5118/16 5131119
PAUL B CAPSON