HomeMy WebLinkAboutAPPLICATIONS PLUMBING & MECH - 18-00518 - 110 W 4th S - The Burg - Remodel I
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�pF SEX BUR fr, C i TY o P Building Safety Department �.
7 (� BUILDING PERMIT FORM 210 City of Rexburg
REXB{. Updated 03/2010 35 North 1St East
America"Family(:amrudty Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Mechanical
For Office i.lrse
Permit Number: Mechanical Fees Paid❑
1,1"t°Iri:rrrrty Owner
Name:
Address: b City: State:40 Zip Code:
Phone: i' (001-L1VYq a Email: • �—
2.Mechanical Contractor
Under Idaho Building Code,a registered con tract�ol,must do the work for a Commercial Building.
Business: RylW1F—,hVt, MW te License#: qV( 41 Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep.Name: RIWi Prll Phone: Email:
Mechanical Contractor Authorized Signature: m ,b Date: 1110
A copy'of yrour-state registrcition/license is required to be on file.If this is the first three you have done work in the City of'Rexbing,please provide
a photo copy ofyour license.Ifyou are unsure ifyour license is on flee,please check with the Pennit Technician by calling(208)372-2341,
3 Project Description
Address:
Description of work: ttl6C" Ps tkyJto-e-\tIPUMV— &w W
. Project Cost::$ 11—T6,00
Cost ofprojec:t:: Calculation for inspection fewer:
If project cost is between$0 to$10,000 then: (Cost of project*2916)+$60
If project cost is between$10,001 to$100,000 then: ((Cost of project-$10,000)*1%)+$260
If project cost is greater than$100,001 then: ((Cost of project-$100,000)*Y2%)+$1160
An additional plan review fee is required which is 10%of the calculated inspection 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 1 swear that any information which may hereafter be given by me in 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 laws relating to the subject matter of this application and hereby authorized representatives of the
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 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.
'W' 0
Applicant's Name(print): (� Signature: Date: il _
Inspections must be called in before 8 AM on the day the inspection is requested.Inspection requests called in a er 8 AM will be scheduled for the next business day.
Inspection Hotline-(208)372.2344 www.rexburg.og Permit Technician-(208)372.2341
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�SaJ',xnt,a4% Building Safety Department
r� C11'Y OP
U 74 City of Rexburg
RE, IZ BUILDING PERMIT FORMZ 3
nPd�ceaosrznno 35 North 1St East
Amcricv"Eapnfly('omnmrnrry Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Plumbing
l or
office Use
Permit Number: Plumbing Fees Paid❑
]rC"tbl:DCI-ty 01011 I'
Name: (\/
Address: WO• W 4TH 5 City: State: Zip Code: SILP40
Phone: 0 �a-
1.Phunbing(ac:nLract'.or
Under Idahn Building Code,a registered contr ctori nust do the work far a Commercial Building°
Business: , i MV�I� VW. State License#: �'C, Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep.Name: NC—Otkl ki Phone: Email:
Plumbing Contractor Authorized Signature, Date: t
A copy ofyour.state registration/license is required to be on file.If this is IIre first i:hne you have done work in the City of Rexbiay please provide
a photo copy of''yo ur license.Ifyou ore unsure if your license is on file,please check ivi'th the Permit Technician by calling(2081)372-234'1.
3 Project Description
Address: 110 h? . HTS S • yq;�4w'0,v
Description of work: WV10-V N' 4t4 "1� -
❑ Project Cost:$ 1 .�
Cos,o4'pt•oject: Calculation for inspection fee:.
If project cost is between$0 to$10,000 then: (Cost of project*2%)+$60
If project cost is between$10,001 to$100,000 then: ((Cost of project-$10,000)*1%)+$260
If project cost is greater than$100,001 then: ((Cost of project-$100,000)*'/z%)+$1160
An additional plan review fee is required which is 10%of the calculated inspection 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 me in hearings before the Planningand 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 laws relating to the subject matter of this application and hereby authorized representatives of the
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 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):T � Signature: Date: ( +�
l�V
Inspections must be called in before 8 AM on the day the inspection is requested.Inspection requests called initer 8 AM will be scheduled forthe next business day.
Inspection Hotline-(208)372.2344 www.rexbm•g.o•g Permit Technician-(208)372.2341
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