HomeMy WebLinkAbout APPLICATION - Mechanical - 18-00285 - 2300 University Blvd - Madison High School Stadium - New ConstructionS haLtA_4^,a- • e.6v�o n z9 (&, 6-aA 6 - o r�
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1E)MURG [BUILDING PERMIT FORM City of Rexburg
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Anterfoa'si4tnjilyC,on+nfunity 35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number:
1. Property Owner
Name: Madison School District #321
Address: 60 W Main
BUILDING APPLICATION
Miscellaneous Mechanical Work
❑ Mechanical Fees Paid
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City: Rexburg State: Idaho Zip Code: 83440
Phone: 208.359.3300 Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to section 4 of this application and complete the Homeowner's Exemption page as well)
❑ No, I am working with the homeowner
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Buildina.
Business: Lewis Corporation
Address: 15136 W Hunziker Rd
Phone: 208.238.1202
Contact/Rep. Name: Kenyan Lewis
City:
. State License #: HVC-C-4440 Exp.: 5-31-19
Pocatello State: Idaho Zip Code: 83202
Email: kenyan@lcorp.com
Phone: 208.238.1202
Email:
Mechanical Contractor Authorized Signature: py o 10-17-18
A ca g � Date:
fyour state re istration license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provic
o photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address:jt'ST) (i,�n���u�• -OR-
What type ofPro erty: ❑ Residenti_al`l 0 Commercial
Cost of job: $?�'7 "
Description of work: 1.41 A–( �
'I. Fees: Check all that apply:
❑ Furnace or A/C = $65
❑ Gas Line = $65
❑ Water Heater = $65
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Lot #: _ Block #: — Subdivision:
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❑ Fireplace/Solid Fuel Burning Unit:
o Built-in= $130
o Free-standing = $65
**Value - $53,137.00 ❑ Miscellaneous/Requested Inspection = $65
Pyrrcon fees can be bundled upon request. Re -inspect fees will be enforced ifinspection requests exceed fee totals.
APPLICANT'S SIGNATURE, CER'T'IFICATION AND AUTHORi7.ATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein
is correct and I swear thatany 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 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 pians on whiclf t e mit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
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Applicant's Name (print): Signature:Date:
10 17-18
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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