HomeMy WebLinkAboutAPPLICATION - 17-00217 - 480 S 1st W - Somerset Lounge - PlumbingC I TY OF
REXBURG
0
Amerim's Family Community
BUILDING PERMIT FORM Z 3O
UpdaW10/2016
BUILDING APPLICATION
Commercial Plumbing
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: Plumbing Fees Paid ❑
1. Property flwner p II I1 qq
Name: tlwN I Iy�Sf2�i — ktAvvftybf,-s r J
Address: TO S I Ws.A City: ¢Xtc "1170( State: T_ Zip Code:
Phone: 4-6`b ME C669 Email:
2. Plumbing Contractor
Under Idaho Bu'ld' Code, a registered contractor must do the work for a Commerci l Bui►ding. s ��
Business: C ��s n�;y State License #: 8 a`53 Exp.:
Address: j 6$4 VO4—wog City: Tllt6 411S Stat - Code: 3L- 0
Phone: 530- Email: &yy\t,
Contact/Rep. Name: Gn coo o u—tm Phone: 141J 5 5 Email: 1
Plumbing Contractor Authorized Signature: �j� Date:
A copy ofyourstate registration/license is required to be onffle. If this is the first timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: L, S j vi ` `` �L
Description of work: V�OJ �fl i�,4c� t� p.rbt`n t 5 [ r e el p�.,p "JL) Low H fe LT
❑ Project Cost: $ 1GOa, 66
• Fees far commercial projects are charged by cost:
o First $10,000=2%+$60.From $10,000to$100,000=1%+$260. Above $100,000 =.5% +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first$10,000 and 1% of the remaining $5,000 = $260 +$50 = $310 total fee
• There will also be a plan review fee totaling 10% of the above fee.
PAID
APR 2 b 2011
City of Rexburg
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l 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 ofthe 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 ifnot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print):
Signature:
Date:
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 - (208) 372.2344 www.rexhurg.org Permit Technician - (208) 372.2341
Xpress Bill Pay - Payment Prorressing
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REXBURG
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XBP Confirmation Number: 29181229
City of Rexburg
35 N 1 at East I PC Box 280
Rexburg, ID 83440
208-359-3020
ub@rexburg.org
Page 1 of 1
Transaction detail for payment to City of Rexburg. Date: 0412612017.1:02:29 PM
Transaction Number: 67557408PT
Visa — XXXX-XXXX-XXXX-5771
Status: Successful
Account # Item
Plumbing Permit
Notes: 480 S 1 ST W
Billing Information
C L PLUMBING LLC
,83440
Quantity
1
https://secure.xpressbillpay.com/common/payment_process.php
Item Amount
$80.00
TOTAL: $80.00
Transaction taken by: mary
4/26/2017