HomeMy WebLinkAboutAPPLICATION PT 2 - 07-00083 - BYUI Hart - Roof ReplacementSUBCONTRACTOR LIST
Excavation & EarthwoAr.
Concrete:
Masonry:
Roofing:
lnsulati(
Drywall.
Painting
Floor
Coverin,
d
Plumbm'
Electrico
Special Construction
(Manufacturer or Suppliers
Roof Trusses:
Flo or/ C effing joists:
Siding/Exterior Ttitn:
Other:
3
m
Building Safety Department
19 E. din
Rexburg, f 83440
State of Idaho
County of Madison
jonellh@rexburg.org
www.rexburg.org
City of Rexburg
Phone,,- .359.3020 ext 326
Fax; 208.359.3024 E 11
Affidavit of Legal Interest
Z�
a
NaiTl@
Bem*g first. duly swan upon oath, depose and say:
Address
State
(If Applicant is also Owner of Retard, slop to B)
�34
CITY OF
E).WURG
America� Family Community
A. That I am the record owner of the property described on the attached,, and I grant mfr
permission to:
Name address
to submit the accompanymg application perta=-ig to that property.
B. I agree to ifidemnify, defend and hold Rexburg City and its employees harmless ftorn anv
claim or liability xesultirig from any dispute as to the statements contained herm'
or as to the
ownership of the property which is the subject of the application.
Dated this day of 20
Signa tu-t
Subscribed and sworn to before me the day and year first above Xvritten.
Notary Public of Idaho
Residing at:
MYconimi'ssion explres.a
EX MP 101, S FROM S
TATE REGISTRATION
As of January 1, 2006., the City of Rexburg can no longer sell permits without having a copy of vour State
registration number of your exemption from the State registrarion. Please send a co r a f our state registration
fill out this form sk�owing your exemption and send it with your license renewal gat your nextpernair application.
�or
('This list is a sumrnarization of Idaho Code Title 54 Chapter 5205, for full defir-Litions of these exemptions please
see the State's website at www..ibol.idaho.tyov/cvnt.htm)
El Currently State licensed pursuant to Title 5-4 Idaho [;ode, Chapters.
3Architects,
� Ll Electrical Contractors/Journeyman,
12 Engineers/Sutv-eyors,
19 Public WolrL-.cz C.,,,tto.-tc.,-,� IAr.. regi ..
, . ..
Lai
u
C
A
4
l
14111.1,11t1� ��UrL1 LC;4' UIlL�:� r���rrauon require�t),
26 Plumbing/plumbers,
45 Public Works C_'or�struction Management Licens'g Act (exempt from fee only registrataon regwired), or
50 Installation of heating, ventilation and air condition2ng systems
Emplovee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable
aCtivity with no wages or salary
employee of a U5 Governi-nent agency (State, pity, County, or other municipality)
Pubhc'Utility doing construction, maintenance, or development,to its own business
Involved with gas, oil or mtt�,e��.l opexa�ions
Supplier doing no ins�rall�tion ox fabricating
Contracting a project ox projects with a total cyst fess than $2040
Operation of a farm or ranch or construction of agriculture buAdings exempt from Idaho Build nor Code
(kny type of water district operations
Work in ruraldis�icts for fire p�revention purposes
D Owner who performs vcTark an own propetty oar contracts with a registered contractor to do work as long as
the ptoperty is not for xesale within 12 months
❑ Owner or lessee of commercial property performing maintenance, repair, alteration or construction on that
prope-tty
u
Real estate licensee /prop e-rt)r manager acting -X�ritiv_n Idaho Code
❑
Engagm'g in the loomingmdustry
11 Renter working on the propetty where they live with the property owners approval
o
Consttuction of a building used fox industrial chemical processing per Idaho Code
o
Construction of a madul_a..r budding (de ed by Idaho bode) to be moved out of state
I hereby certify that the above information is true and correct to the best of my knowledge.
Signature
Print Name
Date
9