HomeMy WebLinkAboutAPPLICATION - 18-00559 - 1370 Stone Dr - New SFRoQ R>rltevRc,
ti o CITY 0 F Building Safety Department
BUILDING PERMIT FORM City of Rexburg
Com! updated 10/2016 O O
Ammica'sFamilyCommunity 35 North 1St East
M!O
Rexburg, Idaho 83440
BUILDING PERMIT APPLICATION
New Single Family Residence
For Office Use
Permit Number: d b 'SS`•1 Zoning:
Application Fee Paid: ❑ $500
1. Property Owner
Name:1%
Address: t`i c_�nt 7i,:�
Phone: i �1 �j- fl�1 L City: _j,,p�/ aa'�- �i State: L9 -f' Zip Code:
EmailIf_ 0 c cyv,-
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: Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name:
3. General C ntractor
Name: Re istration #: Ex t b 23 7:ot
Address: is S , p•'
Phone: a £s Zc } `yt 5 City: x� T, Stat 1 Zip Code: �`{
Email: K,��fti, s t. e,rG L m A,`\ . e-k.,..-
Contact/Rep. Name: — on mail: s�m�
General Contractor Authorized Signature:
d Date: / O 7a %A copy ofyourstate registration/lcense is require to be on file. lfthi
s 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.
4. Project Description
Address: M,j
-OR- Lot #: � Block #: Z Subdivision: 5 �1 Mme ,
Project Description:
• Square Feet: Building Total: sq. ft. 0 # of Water Meters: Water Meter Size:
o Main Floor: sq. ft • Fireplace(s) Being Installed? ❑ Yes ❑ No
o Additional Floors: sq• fL
o Basement: Hydronic Heating Being Installed? [IYes ❑ No
Finished sq. ft,
Building Permit fees for new homes are charged based on square
Unfinished sq_
o Garage sq it. footage and the City's estimated valuation. For details on how fees
are calculated, contact the Building Department There will also be
• Estimated Total Cost: $ a plan review fee totaling10% the building o f g permitfee.
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 1 swear that any
information which may hereafter he given by me in hearings before the Planning and Zoning Commission or the City Council for the City of 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 ofthe 2012 International Code in cases of any f se 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 ifwork stops for 180-day'.
Applicant's Name (print): L �l - Hotline
- (208) 372.2344
Signature: Com'
Date:
Inspection (�o /ZVI
Ins y
pHotlinmust he called in before 8 AM on the day the inspection is requested. Inspection requests called in after AM will be scheduled for the next business day.
www.rexburg.org F Permit Technician - (208) 372.2341