HomeMy WebLinkAboutAPPLICATION PLUMBING - 17-00800 - 60 S 5th W - Kennedy Elementary AdditionCITY a F Building Safety Department
ROURG BUILDING PERMIT FORM 230 City of Rexburg
—� mosserwoom 3S North 1st East
amwaa �m;ycm„mawy Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Plumbing
For Office Use
Permit Number: 11- Oa 8'd10 Plumbing Fees Paid ❑
1. Property Owner 1�
Name: MAf�ISan Select D�SKrTik321
Address: &0 bd Matrti ST City: I t,,X vState: _ Zip Code: 83440
Phone: .20%-2. 9- 3100 Email:
2. Plumbing Contractor
Under daho Building Code, a registered contractor must do the work jar a Commercial Building.
Business: AAofy,'4 ati sT tksnaicA St ate License k:ll' *C-11540 Esp.: 12'31-1%
Address: 1316 W SReo 5 City: itivfo� State: TO Zip Code: 83440
Phone: 26%-356- 0370 Email: aAyntra.M W AA dartct tom.
Contact/Rep. Name: S'noKt- WK Phone: 20$' c
390-920SEma6: $4arr`tf�MwµGAr it*owi
Plumbing Contractor Authorized Signature: d\"— �t— Date: c/9G' /i4
A copy ofyour state registration/license is required to be on flle. If this is the first timeyou have done work in the City of Resting. 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: GO 5 5'ft W i�dR.bvrg
Description of work: Ila b`ao ori rltw W1'4+
❑ Project Cost: $ 351.99 00
» Feesforcommercialpmjecis are charged bycosC
o First$10,000=2% f$60. From $10,000 to$100,000=1%*$260. Above$100,000=.5% f$1,160. 1.e. Work costing
$15,000 will be charged $260 for the first $10,000 and I%of the remaining $5,000= $260 f $50= $310 total
e There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE. CERTIFICATION ANI AIMORIMT10N: Under penalty ofperjurg i hereby came, riot) have read this application and state Nat the information herein
iscorreaandlsw-'r'anyinformatlonwhlchmayhereaRerbegivenbymeinhearingsbeforethe PUnningand Zoning Commksionorthe CityCoundlforthe Cltynf Rexburg
shall be, truthful and correct. IaEree w complywith all City regulators and state laws relating to the subjectmatter of this application and hereby authorised representatives ofthe
City W enter upon the above-mentioned Property for msperdom purposes. NOTE: me building usual may revnkea permit on approval Issued under the proN9ors ofthe 2012
International Cade in cases ofany hlseftatement or misrepresentation ofb.I. theapplicatlon or on the plans on which the permit nrappoom was based. Permitvoid If not
rtaftedwiNlnnoOdays. Permit emid ifamrk stops for 180 days
Applicant's Name (print]: t-01 Signature: _ O V ate. Date:
Inspecdonsymetw (2emoberedhadin before SAM on me day the inspe¢lon is mmiested. Inspection rcquesls called in after O AM xNl be scheduled straw nextbusWgs day.
flonficwww.rexburgarg Permit Technician -(200) 372.2341