HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 18-00424 - 940 N 2nd E - Christensen Body ShoptJ4 gEXB URC
Ua 7 CITY o F Building Safety Department
' REXBURG BUILDING PERMIT FORM City of Rexburg
CWCUpdated 03/2018 O
'•<, America's Familyammunily 35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
New Commercial Plumbing
For Office Use
Permit Number: Ooq q
1. Property Owner
Name:
Address:
City:
Phone:
Email:
Plumbing Fees Paid ❑
State: Zip Code:
2. Plumbing Contractor
Under Idaho Building Code, a registered co>Ztractor must do the work for a Commercial Building.
Business: State License #: G ^ LO (e 5O Exp.:
p•� —
Phone; _�D_Q, =,� $ CIS' tate: Zip Code:
�(_ Email: l
Contact/Rep. Name: Phone:
Plumbing Contractor Authorized Signature: - 4�
A copy ofyourstate registration/license is required to be o
a photo copy ofyour license. Ifyou are unsure ifyour license is o
Project Description
Address:
Description of work:
13 Project Cost: $
Date: ? l_ 2 -Cf
If this is the first timey�havedone work in the City of Rexburg, please provide
n file, please check with the Permit Technician by calling (208) 372-2341.
Cost of project: 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 isgreater than $100,001 then: ((Cost of project - $100, 000) * 36oo) + $1160
An additional nlan revipui too 10 ro ,,, a ..,e
••�-•• .� -�r �,,t cul, uiuceu inspectlon jee
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 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.
Applicant's Name (print):
Signature:
Date:
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