HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00798 - 2211 W 1000 S - Burton Elem. Additionqoa sa•4'e C I TY OF
R�i'�URG' BUILDING PERMIT FORM 230
r�r b mpoin
Amenmk Pnm+b Cominuniy
BUILDING APPLICATION
Commercial Plumbing
Building Safety Department
City of Rexburg
35 North let East
Rexburg, Idaho 83440
For Office Use
Permit Number: l i - 00 NX Plumbing Fees Paid 0
1. Property Owner
Name: MadfSn.. Spk,nnl �iS�+f T #3et1
Address: 60 W MaM ST City: 1C{A Wgl State: 'J_�b ZYp Code:_13440
Phone: ,] 09S - 3S 4 - 3300 Email:
2. Plumbing Contractor
Underldoh , Building Code, a registered anntractor must do the work for a Commercial BuildYng.
Business: /�/.evA}p:n 4lrcT Mtt.l�a kCCA/1 State License #: C-IIS90Exp.: U -31-201S
Address: d"s36 W. 5-1005• City:Email: State: �Z Zip Code: $3440
Phone: a08 - 3S(p-OaTO adml.. ®MWAndtru�,com
Contact/Rep. Name: $haant Find Phone:d0S-340-42of Email: Slwart&hrW W dt,VCl.tVVA
Plumbing Contractor Authorized Signature: Sic, U �,Q Date: t'l- lb-/$
A copy Ofyourstate registration/license is required 0 be on file. if this is thefirst time 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
Address: a2,1% Oil 1000-S li-ubv+�
Description of work: 7%mb".n wr New ddd:WA
❑ Project Cost: $ all, 7(#Z----
•
Z-00• Feesforcommerclalprofecte are charged by cost:
o First$10,000=296+$60. From $10,000 to$100,000=1%+$260. Above $100,000=.5%+81,160. i.e. Work costing
$15,000 will be charged$260for theflrst$10,000 and I% of the remaining $5,000=$260+$50=$310$ total
totaljttaljee
• There will also be a plan review fee totaling 10% of the above fee.
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperryry, I hereby cef "o,I have read drifts application and state that are informatlon Rehr
Is coma and l swear Mat any l nformrtl on which may hereafter be given by mein hearings before me Planning and Zoning Commission or the City Council hr the City of Rexburg
shallbstruMfulendrorreec. Iagree to amply with all City regulations and State laves wrong to Me subject matter orthis application and hereby accounted representatives ofthe
Clry to enhrvpnn th¢above-mendoned pmperryfnr inspettlons puryw s. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
International Code In cases clear false shhment or Md
ireprewnHon of but in the Application or on plans on which Me permit or approval was based. Permitvoidlfnot
startedwlMln 100 days. Perot vold Ifworkstops forlSO days
Applicant's Name (print): Ad"i pt Signature: %O_ µ.:—ms. Date:
Inspections mumbe elledin before 8 AM re
Man the day theinspection is questedrequests . hos ecron requescalled In after 8 AN will be schMnledforthe next business day.
Inspection Holme-CiraT 372.2344 www.rexburg.oB PenNt Technician -(208) 372.2341