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HomeMy WebLinkAboutAPPLICATION - 17-00796 - 367 E 7th N - SFR Mechanical OnlyCITY OF Bl1ILDING PERMIT FORM Ow Update 10/2616 F ffm iark Fan[ti} CaZ1R7r{l dly BUILDING APPLICATION Miscellaneous Mechanical Work Building Safety Department City of Rexburg 35 North 15t East Rexburg, Idaho 83440 For Offlce Ilse Permit Number: © Mechanical Fees Paid 1. Prop ( nX�rC ? If Name: 1u Address: City: k/0state: 1 Zip Code: Phone: D / d %J C 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 Homeowners Exemption) No, I am working with the homeowner Z, Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business:� �+Ia/ V/�-G' LLC/ State License #: Q � (f-1 + E Address: Z1 C-7, 12D 1 Ciry: 19d State: ID Zip Code: e�' Phone; j 9 to Email: 1-'b 4 03 6 M61 Contact/Rep. Name: �tl Mechanical Contractor Authorized Signature-. r/ 4 .t -ems Date: A copy ofyour state registration fikense is required to be on file. If this is the first tame you have done work in the City of Rexburg, please provide a photo copy Qfyour license. Ifyou are unsure ifyour license is on file please check with the Permit Technician by calling (208) 372-2341. . Project ^��ri! fitl�� Address: `2 C � -OR- Lot #: _ Block #l: _ Subdivision: ,{{� What type of Property: -Residential ❑ Commercial Cost of job-- $ I Description of work: -tel �� d i J{ ".' t 4� � `�f M/G ZS' IIS f 00,0 8TLI Fees: Check all that apply: Furnace or A/C = $65 ❑ Fireplace/Solid Fuel Burning Unit: Gas Line= $65 o Built-in= $130 ❑ Water Heater = $65 o Free-standing = $6S ❑ MiscelIaneous/Requested Inspection= $65 Inspection fees can be bundled upon request: Re -inspect fees will be enforced if inspection requests exceed fee totals. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATI ON: Under penalty of perjury, l 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 me in hearings before the Planning and Zoning Commission or the City Council forthe City of Rexburg shall he 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 apermit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of factin 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 workstops for 180 days. Applicant's Name (print): L n ' W �� Signature: Date: r% Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline- (208) 372.2344 www.rexburg:org Permit Technician- (206) 372.2341