HomeMy WebLinkAboutAPPLICATION BUILDING PERMIT - 18-00557 - 1382 Stone Dr - New SFROQ 1tEXBUgC
CITY of: Building Safety Department
o J�EJXLBv1tG BUILDING PERMIT FORM 100 City of Rexburg
. h+ Updated 10/2016 Family Communi
America35 North 1St East
Y't+,,.p .•' 's ty
Rexburg, Idaho 83440
BUILDING PERMIT APPLICATION
New Single Family Residence
For Office Use
Permit Number: 1Tf -00 5S 1 Zoning:
1. Property Owner
Name: Vi iZ
Application Fee Paid: fn.Smn
Address: e to 3Ya� W City: _J'AVt��-�+� $1� 1'tS
Phone: State: 1).' Zip Code: -
X13 S �6 y - 0,ial Email: �f � h�u,/► is; l �•�
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)
:�QNo, 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: J 6 t%"- Re istration #: CN" —90'
Address: 0 S , Exp.: it)
Phone: L20is Zo* `71-ib5 Cid'' X,1� R.i7 Static: 11�T Zip Cole: �' 444
� Email: 47 at d� !G n, A" • G,r.—
Contact/Rep. Name: I l r on lam" t -7 at mail: spm
General Contractor Authorized Signature:
A copy of your state registration/license is required to be on file. If this s the first time you have done work in the City of Rexburg, pteaseprovide
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: -OR- Lot #• � Block #: 3S ((�� m> a
Subdivision• I :;y„
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: $
• # of Water Meters: Water Meter Size:
• Fireplace(s) Being Installed? D Yes 0 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. I herebycertify 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 me in 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 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 180.days.
Applicant's Name (print): ` I - Signature: .
Date: ( to Ldl
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 the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org
Permit Technician - (208) 372.2341