HomeMy WebLinkAboutAPPLICATION MECHANICAL - 17-00766 - 125 Valley River Dr - Stan's Paint - Tenant Improvementox vrxauko,
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BUILDING PERMIT FORM 21�
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BUILDING APPLICATION
Commercial Mechanical
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Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
POTOfhice Use
Permit Number:11" 00 Mechanical Fees Paid ❑
L Propos- Own('!
Name: GICGHAIV — GKL ?RotPEf,Tt(=S
Address: LAS- V,P"Gi' II&WEV- DR. City: State: �D Zip Code: $3 yyd
Phone: _ 3 /0 - 800 - 8 8t.o L/ Email:
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Under Idaho BuildingCode, a registered contractor must do the work for a Commercial Building.
Business: �P11-'IR 'cQa METf,L WoRkS f r'NC State License #: �"iVC-'C'-i l9 Exp.: o�a.0
Address: PPO ?pox 1'k City: G.LL-Cv State: T 1) Zip Code: $3a 7 y
Phone: Email:QGn�- GemMe'rt/a�mata.(woRfl,✓1c•ce
Contact/Rep. Name: (23SNG— 04Q-tr.S Phone: AIDS -3 tEn1il: sarnr_
Mechanical Contractor Authorized Signature: �" Date:— f 6
::1) ofyou+'statere(tretru.i �r./4t ensei�;equil ed to be on file [fthis +s tha;5rstrme you have stone work In the City of 31cx-rr.r., p1ctrce2„
..,>,:oly�ft�ur ir��ns.tt��i.,;;T unsure ifpa!u'license Y,r on Jiie,pleose check ii=ith the Permit iechr;u'ian 5v cr.itb•t,r rk;),3'R ^:i:l.
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Address: 1e15 t/pl-t-d, A(VE)�' 83Y
Description of work: 1�ll=tJ tZoar Cod utUiT/GP5 J30CXWea9'�
❑ $ ISO Igo -
• Feesfor commercial projects are charged by cost:
o First $10,000 = 296 + $60. From $10,000 to$100,000=19'0+$260. Above $100,000=.545+$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 195 of the remaining $5,000 = $260 + $50 = $310 total fee
• There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l 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 State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon theabove-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 ifwork stops for 180 days.
Applicant's Name (print): 146 k l -J- Signature: ,/ f ' " ':V0 Date: - el -1 a
Inspections must be called in before a AM on the day the inspection is requested. Inspection requests called in after B AM will be scheduled for the next business day.
Inspection Hotline- (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341