HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00613 - 900 Jet Stream Dr - Headwaters Construction - HeadquartersCITY OF
RMURG
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BUILDING PERM IT FORM 230
Updated 10/2016
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. Pro er Owner
Namepetco�ldlc PPS ! dNs/rUG�iDi✓
Address: 1410 Z t bT, City: U% s State: A lZip Code:
Phone: m,6 - Imb - 9W V Emai] `lit til ay //e�l✓ iP✓S L'C GD
2. Plumbing Contractor
Under Idaho' 1Building Code, a registered contractor must do the work for a Commercial Building.
Business: AoleS%t(Jf PG�V—Y�Ih�n(n-t� �C� State License#: 1PL2-C-((517 Exp.: II l
Address•�q& E swo,) 5lDD Kd LltJtr 1 City: -a o�rJ —State: TO Zip Code: ff33g0G
Phone: ?06l 535^1 oU --Email: r�ote5 t smb;n CA a in,60, Cor"
Contact/Rep. Name: ID4.le S. doh n Soot. hone: l7 ) 3( -/Oa) Emai1:�D125tia{p JYn ;fie [a VT_e
Plumbing Contractor Authorized Signature: Date: //
A copy ofyour state registration/license is required to be on file. If this is the st ttmeyou 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 by calling (208) 372-2341.
3. Project Description
Address: �%�0 JF% Sf19Yh 7Y/iJ
Description of work: ['U/�1mErZC/RL �LrJ/»B/yc/G-
❑ Project Cost: $ 19,N00 a co
• Fees for commercial projects are charged by cost.,
0 First $10,000 = 2% + $60. From $10,000 to $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 146 of the remaining $5,000 = $260 + $50 = $310 total fee
• There will also be a plan review fee totaling 1OVoo of the above fee.
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 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 1n 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):�ak -S ZgnfDn/ Signature: Date: /1110111
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.rexburg.org Permit Technician - (208) 372.2341