HomeMy WebLinkAboutAPPLICATION MECHANICAL - 19-00047 - 358 E 2nd S - Lincoln Elementary School - AdditionCITY OF
REXBURG
America's Family Community
BUILDING PERMIT FORM
Updated 03/2019 210
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
COMMERCIAL MECHANICAL BUILDING APPLICATION
0 New Construction Addition 0 Remodel 0 Tenant Improvement 0 Accessory Structure > 200 sq. ft
For Office Use
Permit Number: Mechanical Fees Paid 0
L Property Owner
Name: 1....: \A.C...OVA. GiVe_vv...2 a..s./...i
State‘. Zip Code: 95 -gt-PE0 Address: "z)c- C, 2k,ck S City: ...s1--v..--kit
Phone: Email:
2.Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: ..,:)M- V1/4-Q-c-SCA-0--0-‘, l. J..—C.... State License #: C:)-- Exp.: k \ I ..C..2,1 -W .
Address: -2;1-1 ‘..) '7...C;C> U.) City: kSmc-Vz- 'ca-ii.A4--- State: k..5-C- Zip Code: 'i31.--L7zA.eic
Phone: 14-2c-NC---Czinz,-lics7 (..i-1 Email: \Ao_rt - 8.CA-A-V:;) . _ c_c_3....-,,
Contact/Rep. Name:
Mechanical Contractor
A copy of your state
a photo copy ofyour
I.V_ct.--‘,..$)..4,- r•--t.k.. Phone: t-V&C-9;1-% - Ci2.3Email: 1/4..2 c, -a,1/411 .. ad • vt.,,,vv.A2
I,
Authorized Signature: F _ Date: , Air _O-dAs_A__
registration/license is required to Wan file. If this is the first time you have done work in the City of Rexburg, please provide
license. If you are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3.Project Dem_Tiption
Address: -.2-4-- Q 2.1,,Afr '-. •
('1..- Va-C-'" Description of work:
gl Project Cost: $
vow '-'c L.D et et.; \„•al".A.L.C1-v iF;
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Cost of project: Calculation for inspection fee:
$0 to $10,000 then: (Cost of project * 2%) + $60
$10,000 to $100,000 then: ((Cost of project - $10,000) * I%) + $260
Greater than $100,000 then: ((Cost of project - $100,000) * 1/2%) + $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 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): ‘--\e_CSv Signature: QQ.1 Ack..126 Date: (3(.1.)
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 nest business day.
Inspection Hotline -12081372.2344 www.rek-bure.ore Permit Technician -12081372.2341