HomeMy WebLinkAboutAPPLICATION PLUMBING - 19-00140 - 693 S 2275 W - New SFR�r
CITY OP
REXBURG
Aoiedm's Family Community
Building Safety Department
BUILDING PERMIT FORM 3 ® City of Rexburg
"dmed 10/2010 35 North 1st East
Rexburg, Idaho 8344.0
BUILDING APPLICATION
New SFR Plumbing
For Office Use
Permit Number: ❑ Plumbing Fee Paid
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone: Email:
tinder Idaho Building Code, a homeowner is allowed to do work on their own home,
Are you a homeowner doing work on your own home?
f❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Plumbing C ntractor //��
Business: C� e5 /D/w, ,:,,!` I1 State License#: /a C�/ xp,:
`� ° z- •"t a,.' / /(i r °tee -r State:: Zip Code: p ��
Address: ,�/_� _,s � .� �
Phone: 7c"6 5-3 % ('C) Email: l r%3Xo'f/, /1, 1.,
Contact/Rep. Name: eel Phone: Emal.
Plumbing CtintractorAutho-Izt it Signatut'e: `' 1 Dater f
A copy ofyour state registration/license is required to be on file. If tills lsrt first time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure if yonr license is on file, please check with the Permit Technician by calling (208) 372.2341.
3, Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
Description of work:
❑ New SIR Construction: sq, t.
• Gees for new construction are charged by square footage: Up to 1,500 sq. ft. = $130 + $65 for each additional 1,000 sq. ft or portion
thereof.
o Up to 1,500 sq. ft =$130, up to 2,500 sq, ft. =$195. Up to 3,500 sq, h. =$260. Up to 4,500 sq. ft. = $:325, etc. (i.e. a
home with 3,675 sq. ft. will be charged $325)
Hydronic (in -Floor) Heating: ❑ Yes ❑ No
4 Note that hydronic heating is not included in square footage costs and will be charged $65 + ($1 o x # of manifolds/zones).
APPLICANT'S SIGNATO RU, CERTIFICATION AND AUTIIORI7.ATION: Under penalty of perjury, l hereby certify that 1 have read this application and state that the Information herein
is correct and I swear thntany Information which may hereafter be given by me in hearings before the Planning and'lolthlg commisslon or ilia City Council for the City of Rexburg
shall he truthful and correct. I agree to comply with all City regulations and State laws relating to ilia subject Inatler 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 tinder the provisions or tine zoi 2
International Code to cases orally false statement or misrepresentotion of fact In the application m• on the plans on which the permltor approval was based. Permit void If not
started within 1110 days. Permit void if worst stops for IRO days.
Applicant's Name (print):
__ —Signature:
Date:
Inspections trust be called hl before 0 AM oil the day lho Inspection is requested. inspection request.s called hi after 0 AM will be schedtded for the next business day.
Inspection (hotline - (200) 372.2344 www.rexburg,org Pariah Technician - (200) 372.2341