HomeMy WebLinkAboutAPPLICATION 2 - 18-00495 - 1385 Stone Dr - New SFRoQyt> xeupc,
�F o� CITY OF Building Safety Department
RM�URG BUILDING PERMIT FORM 100 City of Rexburg
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Rexburg, Idaho 83440
BUILDING PERMIT APPLICATION
New Single Family Residence
For Office Use
Permit Number: I R- o U y qs Zoning:
1. Property Owner
Name: V Y (7,
Application Fee Paid, ❑ tSnn
Address: 2t`i ecu '�i ✓a r
Cit,':--,-�--- State: UZip Code:
Phone: _!` y�S liby- Dy�L Email:_za�t
Under Idaho Building Code, a homeowner is allowed to do work on their own home. 4�yw
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #4 and complete the Homeowner's Exemption)
:P,�No, I am working with the homeowner
2. Applicant
Name:
Address:
Phone:
Contact/Rep, Name:
3. General CVntractor
Role: (Owner, Tenant, Contractor, etc.)
City:
State: Zip Code:
Email:
Name: i t_%�L Re istration #: �0% --1dZ��
Address: u S , Exp.: l b 23 Zo
Phone ofs Zoi — `1Ltl, CIS" Zip Code:
EmPA g M ++,' %' . c
ail:
Contact/Rep. Name: p �1i0n t ��,t
.hm
on s►�m
General Contractor Authorized Signature:
A co 0 9 h f Date:
copy ofyour state registration/license is required to be on le. l this s the first time you have done work in the City of Rexburg, please provi
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling f2 08) 372-2341.
4. Project Description 11
Address: Xwi5r
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 sq. ft.
Estimated Total Cost:
-OR- Lot #: — Block #: _ Subdivision:
• # of Water Meters: Water Meter Size:
• Fireplace(s) Being Installed? Cl Yes ❑ No
• Hydronic Heating Being Installed? ❑ Yes ❑ No
Building Permit fees for new homes are charged based on square
footage and the MY'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 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 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 withall 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 ases 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 if work stops For 186days.
Applicant's Name (print): ► `t - Signature: / be/ l/'Date; ( �o
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after AM will be scheduled for t
Inspection Hotline - (208) 372.2344 www.rexburg.org he next business day.
/ Permit Technician - (208) 372.2341