HomeMy WebLinkAboutAPPLICATION - 18-00662 - 77 S 1st E - Kitchen remodel04 gEXB URC
uF o� C I TY OF Building Safety Department
° EIx-B 1t%1 BUILDING PERMIT FORM 100 City of Rexburg
(� Updated l0/2016 35 North 1St East
'•< America's Family Community
Rexburg, Idaho 83440
For Office Use
Permit Number:
BUILDING PERMIT APPLICATION
New Single Family Residence
Zoning:
Application Fee Paid: ❑ $500
1. Property Owner
Name: 54
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Address: City: Nona (71 State: _ Zip Coder 3 44C)
Phone: 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 #4 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Applicant A .^
Name: _ f ' N" A'-� Role: (Owner, Tenant, Contractor, etc.)
Address: City:
Phone:
Contact/Rep. Name:
3. Gen Contractor
Name
Address:, `��,<�� \ City:
Phone:\�—
Contact/Rep. Name: Phnr
General C t
State: Zip Code:
Email:
Registration
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��-�''_State:kk-�. Zip Cod613 t L[
Email:
Email:
on ,actor Authorized Signature: ZIL-x 14 - Date: 1Z— 1 � I
A copy ofyour state registration/license is required to be on file. If this is the first time you have one 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 _
Address: :�t_` � -OR-
Project Description:
Square Feet: Building Total: sq. ft.
o Main Floor: sq. ft.
o Additional Floors: sq. ft.
o Basement:
Finished sq. ft.
Unfinished sq. ft.
o Garage sa, ft,
Estimated Total Cost:
Lot #: _ Block #: _ Subdivision:
• # of Water Meters: Water Meter Size:
• Fireplace(s) Being Installed? ❑ Yes ❑ No
• Hydronic Heating Being Installed? ❑ Yes ❑ No
Building Permit fees for new homes are charged based on square
footage and the City's estimated valuation. For details on how fees
are calculated, contact the Building Department. There will also be
a plan review fee totaling 10% of the building permit fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 1 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. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print). � "Signature:
Date: lZ-'�
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be schedu ed for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org
Permit Technician - (208) 372.2341