HomeMy WebLinkAboutAPPLICATION - 19-00360 - 1112 Horizon Dr - New SFRInspection Hotline – (208) 372.2344 www.rexburg.org Permit Technician – (208) 372.2341
Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440
BUILDING PERMIT APPLICATION
New Single Family Residence For Office Use Permit Number: ____________________ Zoning: ______________________________ Application Fee Paid: ⧠ $500 1. Property OwnerName: Paul and Jeanette Evans Address: 321 Parkway Circle City: North Salt Lake State: UT Zip Code: 84054 Phone: (801) 510-2306 Email: evans.pauls@gmail.com
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) ⧠ No, I am working with the homeowner 2. ApplicantName: __________________________________________________________ Role: (Owner, Tenant, Contractor, etc.) _______________________________Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________Phone: _____________________________________________ Email: _____________________________________________________________Contact/Rep. Name: _________________________________3. General ContractorName: _____________________________________________________________ Registration #: _________________________ Exp.: _______________________Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________Phone: _____________________________________________ Email: _____________________________________________________________Contact/Rep. Name: ______________________________________ Phone: _________________ Email: ______________________________________________General Contractor Authorized Signature: ____________________________________________________________________ Date: __________________
A copy of your state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide
a photo copy of your license. If you are unsure if your license is on file, please check with the Permit Technician by calling (208) 372-2341. 4. Project Description
-OR- Lot #: ____ Block #: ____ Subdivision: _________________________________ Address: 1112 Horizon Dr. Project Description:
•Square Feet: Building Total: 11,298 sq. ft.
o Main Floor: 3370 sq. ft.
o Additional Floors: 1791 sq. ft.
o Basement:Finished 3751 sq. ft. Unfinished 816 sq. ft.
o Garage 1790 sq. ft.
•Estimated Total Cost: $ 850,000
•# of Water Meters: _________ Water Meter Size: __________
•Fireplace(s) Being Installed? ⧠ Yes ⧠ 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 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 2012 International Code in cases of any false 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): Paul Evans Signature: _____________________________________________ Date: 6/14/19 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.
BUILDING PERMIT FORM Updated 10/2016 100
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