HomeMy WebLinkAboutMECHANICAL APPLICATION - 18-00107 - Courthouse - RemodelCITY OF
REXB V RG BUILDING PERMIT FORM 21
OW upa.ua10/2016
AmErW Family Community
BUILDING APPLICATION
Commercial Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Mechanical Fees Paid ❑
1. Property Owner
Name: Madison County
Address: 134 East Main Street City: Rexburg State: Idaho Zip Code: 83202
Phone: 208.359.3020 Email:
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the work fora Commercial Building.
Business: Lewis Corporation State License #: HVC-C-4440 Exp.: 5-3-19
Address: 15136 W Hunziker Rd City: Pocatello State: Idaho Zip Code: 83202
Phone: 208.238.1202 Email: kenyan@lcorp.com
Contact/Rep. Name: Kenyan Lewis Phone—2Q8.238.1202 Email: kenyan@lcorp.com
Mechanical Contractor Authorized Signature. Date: 6-26-18
A copy ofyour state registration/license is requir to be file. s is thefirsttimeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure if cense is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: Madison County Courthouse, 134 East Main Street, Rexburg, Idaho 83440
Description of work: HVAC Upgrade
❑ Project Cost: $ 91,428.00 }
• Feesfor commercial projects are charged by cost,
0 First $10,000 = 2% + $60. From $10,000 to $100,000 = 1916 + $260. Above $100,000 = .5% +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total
• There will also be a plan review fee totaling 10Vo of theabove fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein
is correct and I swear that any information which 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 Sure laws relating to the subject matter of this application and hereby authorized representatives ofthe
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 ofthe 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. Permitvoidifnot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): Q7S Signature: Date: �Iff
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