HomeMy WebLinkAboutAPPLICATION 2 - 17-00263 - 460 W 2nd N - Madison County Fairgrounds Grandstand BathroomCITY OF REXBURG
PAID BY: REXBURG PLUMBING R HEATING
DATE: 05/10/17 MF /0510/CNTR
TIME: 15:23:27 RECEIPT NO: 458471
REF NO: 11957
2 BP FLUME. PERMITUNDE 428,70
CHECK AMOUNT
PAYMENT
CHANGE
FAIR GROUNDS NEW BATHROOMS
428.70
428.70
0.00
BUILDING PERMIT FORM 230
updar 10/2016
BUILDING APPLICATION
Commercial Plumbing
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
Plumbing Fees Paid ❑
City: State: :LQ Zip Code: _ j"-(
Ema'
I contractor must do the work for a Commercial Building.
State License #: j?i�{ 3 `` Exp.:
Address: Ve 5 1 U City: State: -c2_ Zip Code:
Phone: `j�_$�' Emai
Contact/Rep. Name: 01n'. LkY 4 Phone: Email:
Plumbing Contractor Authorized Signature:- Date:
A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide
a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician bycalling(208) 372-233441.
3. Project Descr[irption
Address: L
, 1 C d gfN�S CY Og2p l4yf t1/M J
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Description of work: /JP.oJ {"1'Inslrrlv�✓)
❑ Project Cost: $ 00
;$�._
• Feesfor commercial projects are charged by cost:
0 First $10,000=2%+$60. From $10,000 to $100,000=1% +$260. Above $100,000=,596 +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 140 of the remaining $5,000 = $260 + $50 = $310 total fe
• There will also be a plan review fee totaling 10% of the above fee.
26 0 s t
y -U
PAID
MAY 1 n 2017
City of Rexhimy
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information herein
is correct and I swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct. 1 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 ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifnot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): Signature: Date: 2A �T
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 - (2 08) 372.2344 www.rexburg.org Permit Technician- (208) 372.2341