HomeMy WebLinkAboutAPPLICATION - 19-00113 - 2172 W Hwy 33 - County MechanicalCITY O F
REXBURG
Americo Family Community
BUILDING PERMIT FORM Q,1�
Updated 2/2Q37
BUILDING APPLICATION
Miscellaneous Mechanical Work
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fees Paid
1. Prope O n r n
Name: V� ' t /
Address:9qL; City: State: _ Zip Code: Z
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?
6d13 Ye (Skip
d(Skip to section 4 of this application and complete the Homeowner's Exemption page as well)
Na,
NI am working with the homeowner
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the work far a Commercial Building.
Business e tate License #: E O
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AddreNO
ss: City: State: Zi de.
Phone; aIAV IP
Contact/Rep. Name: � Phone Email:
Mechanical Contractor Authorized Signature: -Date:§3q- /I T,
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A copy ofyour state registrationlicense is required to be on z t fir ou have done work in the City of Rexburg, plea e provide
a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341,
3. Project Description
Address: -OR- Lot #: Block #: Subdivision:
What type of Property:esldential ❑ Commercial
Costof job:
Description of work:
4; �Fs: Check all that apply:
Vurnace or A/C = $65 ❑ Fireplace/Solid Fuel Burning Unit:
(G;as Line = $65 o Built-in = $130
❑ Water Heater = $65 o Free-standing = $65
❑ Miscellaneous/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 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 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 2412
International Code in cases of any false statement or misrepresentation of fact in the application or an the plans on which the permit or approval was based. Permit void if nat
started within 180 days. Permit voiq if work stops for 160 days.
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Applicant's Name [print : Signature: Date: 10
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- (208) 372.2341