HomeMy WebLinkAboutPA SUMMARY - 19-00267 - 566 Park St - New Water LineCITY OF
REXBURG
Am*ieals Family C,o mmunity
i nunprrote pc*.&Ilr'.t-CIly F50l it---. -.. .-._.
Building Safety Department
City of Rexburg
35 North Lst East
Rexburg ldaho 83440
For Office LIse
Permit Numberl D Plumbing Fees Paid
i. Plope{Or.^,tuer
Name:
Address:City:State: AD zipcode: 831'ltlo
Phone: (Zo
Under ldaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
tr Yes fSkip to #4 and complete t}te Homeowner's Exemption)
Mtto, t am working with the homeowner
2, PlLrmhing {loiitracior
Under ldaho Building Code,a registered contrac'tor must do the workfor a Commercial Building,
Business: Chod [J"11 C^-s\.rrra-ka-I'ae State License #: RCf, - t 15 Zq Exp.: 6\ - ztt - 2ozo
Address:City:Sate: f$ Zip Code: ?3440
Phone: OoA)?<L--70u6 Ernaili Cuslornba.cKh..a @ rnsn. covn
Contact/Rep. Name:Phone: &,og) 3co - 5ae3 rmaitr
Plumbing Contractor Authorized Signature:Date:5- lo- lq
A copy ofyour state registration/license is required to be on file.is the first time you have done work in the Ci4t of Rexburg, please provide
a photo copy ofyour license. Ifyou are Lrnsuie ifyour license is on file, please check with the Permit Technicion by calling {208) 372-2341.
3. Proiect ilersclipiiorr
Address: 5G6 ParK S\'ee\
What type of Property:
Cost ofjob: $-
dkesidential trCommercial
walrar lino-Description of work:
4. irees: Check all that apply:
n Gas Line = $65 n Hydronic Heating = $65 + {$10 x # of
tr Water Heater = $65 manifoldsfzones) = $-
n Sewer Line = $65 B Miscellaneous/Requested inspection = $65
il Water Line = $65 n Sewer Turnaround fseptic to city) = $6'5
n Lawn Sprinklers,/Backflow device = $65 hspectionfeesconbebundleduponrequesLRe-inspectfeeswilIben Gray Water Systems = $130 enforced if inspection requese exceedfee totnls.
BUITDING APPIICATION
M isce II aneous P lumbing W o rk
APPLICANT'SSIGNATURE,CERTIFICATIONANDAUTHORIZATI0N; Underpenaltyofperiurylherebycertify&atlhavereadthisapplicationandstatethattheinformationherein
is correct and I sear that any infomation which may hereafter be given by me in hetrings before the Planning and Zoning Comnission or the City Council for the City of Rexburg
shallbetrutlfulandcomecl IagretocomplywitlallCityregulationsandStatelamrelatingtothesbitrtmatterofthisapplietionmdherebyautlorizedrepreentativsofthe
Citytoenterupontheabove-mentionedpropertyforiEpstionspurpos6. NOTEr Thebuildingoffcialmayrevokeapemitonapprovalissuedundertheprovisiomofthe2012
lmpsbons must be called in before B AM on the day the inspection is requsted. In+ection requests called in after 8 AM will be sheduled for the next busiDes day.
Inspection Hodine - (208) 372.2344 wwnrexbu rg.org Permit Technician - (208) 37 2.2341