HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00695 - 66 E Main St - Progrexion - RemodelCITY O F
R.EXBiRG
America's Family Communify
BUILDING PERMIT FORM Z
Updated 10/2016
BUILDING APPLICATION
Commercial Plumbing
Building Safety Department
City of Rexburg
35 North Is' East
Rexburg, Idaho 83440
For Office Use
Permit Number: Plumbing Fees Paid ❑
1. Propedrty� Owner
Name :vtEIir.V" -Z-
Address:
ZAddress: )09 b 1A rn n►i hl 1n kyr yjd city: State: L14- Zip Code:
Phone: Email:
2. Plumbing Contractor
Under Idaho Building Code, a registered contractor must do the workfor a Commercial Building.
Business: A1.2liu—toS PlmtV�;-h,— 9 , State License #: C -- Exp.:
Address: -9L1-2— 501 ,iJ i 51(4t City: 6tv /VL r State: .-T-b Zip Code: 85-2-7q
Phone: - 352 - 3q 39 > mail:. _rn t V" /7'1®c �Gie cy5 Alcr�rr !sr y . YVU�
Contact%Rep. Name: Phone: -35-�-3%7g Email:
Plumbing Contractor Authorized Signature: Date:
A copy ofyour state? registration/license is required to he on file. If this is the first tune you 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 t
Address: ka • 415• /P4749 +3 '
Description of work: �o ,pd
❑ Project Cast: $
• Fees far commercial projects are charged by cost,
o First $10,000 = 2% + $60. From $10,000 to $100,000 = 1 % + $260. Above $100,000 =.5910 +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first$10,000 and 1916 of the remaining $5,000 = $260 + $50 = $310 total re
• There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the infarmaUun herein
is correct and I swear that any information winch 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. I agree to comply with all City regulations and State iaws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the ahove-mentioned property for inspections purposes. NOTE: The building official may revoke a permit an 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): i tt'- i iMl,r� Signature... -W Date:
Inspections must be called in before 8AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next husiness day.
Inspection Hotline- (208) 3722344 %vww.rexburg.org permit Technician - (208) 372.2341