HomeMy WebLinkAboutAPPLICATION PLUMBING - 18-00161 - Olive Avenue - Additiond C]TY OF
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BUILDING PERMITIT 230
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BUILDING APPLICATION
Commercial Plumbing
Building Safety Department
City of Rexburg
35 North let East
Rexburg, Idaho 63440
For Office Use
Permit Number: k4'"k116 ( Plumbing Fees Paid
1. Property Owner
Name: ri
Address: lyw-nhrmM �e.To.emrry-s
5kngc 4_ city: ';�ge xbb state: 2s: qD Zip Code:
Phone:Sa3 -6'S la-bfrLs Email:` -a+ri_ min®.;sw+aCA .GcYh.
2. Plumbing Contractor
UnderIdaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: /-K>us LisleF�I r3a� rJ`rC State License #: PLLr C -1265- Exp.:
Address: y0 /y 41N City: Si.iimrTgoi+u State: 2d- Zip Code: 83YVS
Phone: .�t66-63`f-3777_ Email: $'1 c e�
Contact/Rep. Name: nut Phone: 208 'Email: hpgwPS rle+Scaspelna,I
Plumbing Contractor Authorized Signature: Date:
A copy ofyour state reghuration/license is required to beonfile. Ifthis is thefirst tit eyou havefilifrOnork in the City Of Rexburg, pleasepradide
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: �
Descriptio f k OQ1um'1'F&*x,,,aCM
Cl Project Cost: $ fii
• Feesforcommercial projects are charged by cost
o First$10,000=296+$60. Front$10,000 to$100,000=1%-$260.Above$100,000=.596+$1,160. i.e. Work casting
$15,000 will be charged $260for the first$10,000 and 1% of the remaining $5,000= $260+$50= 5310 Will fee
• There will also be a plan reviewfee totaling 10% ofthe aborefee.
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read MIe application and Aide that the intonation herein
is rrertand I new, don.winfnrrnatlon which may hereaRerhe givan by mein hearings before the Planaingand coning Commission or the Cityconnal far the City of Rexburg
Aallla thfuland,.rvO. Iagree mromply with all City regulations and Stitt laws reUEng to thesubut matter of this application and hereby authorized repre entatves from
Cityto enter uponthe+hove-mmnoned property forinspec[iorts purposes. NOTE: no building official may revoke a permit on approval Iseued under She provisions ofthe 2012
Stoomtlonal Cade in cases stony falsesta[ement or miseepresentatlon offset inthe application or on the plans on which the permit or approval was based PernAvoidifnot
started within 180 days. Permit void ifworkstops for 180 days
Applicant's Name (print):
Inspections must be called in before SAM on the day the Inspection is requested. Inspection ratings called in after AM will be scheduled far +a beat business day
pecnH.
Instiootlins-(200] 372.2344 www.reelar'.arg Permit Technician -(208) 372.2341
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