HomeMy WebLinkAboutAPPLICATON - 19-00494 - 19 E Main - Plumbing - Mrs Powell's04 gEXB URC
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° Rexburg Building Department 31 N 1st E
m Rexburg, Idaho 83440
T Ph: (208)372-2160
9B`'S7t E0 ,eeA Plumbing Permit Application rexb_urg.org
Please fill out this application completely and submit with payment. If you have questions or need assistance completing the application, please call the
Rexburg Building Department. Please note: permit fees are non-refundable and non -transferable.
1. Property Owner j
Name: wt �►eGl1MAe'.?VVq&(('S G
Address: City: State: Zip Code: 03+f 0
Phone: Email: �Ah ov - C o kvl
2. Plumbing Contractor
Under Idaho Buildmq �Code, 'a'registered contractor must do the work for a Commercial Building.
Business: NGL vvrivvS �,( State License #:
Address: Exp.:
C'
Phone
tty.
State:
Email:
Contact/Rep. Name: MI"d.t)K L-0 — Phone: 2&- &&(-)- QaQ hmail:
Zip Code:
A copy ofyour state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please
provide a photocopy ofyour license, Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208)
372-2160.
DESCRIPTION OF WORK:
JOB SITE ADDRESS:
CITY: Cir
DIRECTIONS TO JOB SITE:
ZIP: vl�� COUNTY: MAJAI;b Il
JOB NAME:
AN ADDITIONAL $65 FEE MAY BE ASSESSED if a re -inspection of the project is required.
THIS PERMIT APPLICATION IS NOT AN INSPECTION REQUEST: To schedule inspections please call (208) 372-2344
It is the responsibility of the permit holder to arrange access to the premises with the property owner in order for the city
to complete the inspection.
We Accept: cash, check, money order, Visa and MasterCard
Make checks payable to the City of Rexburg
GRAND TOTAL FEES P
*Please use the worksheet on page 2 to determine the total fees and enter the amount to be paid here.
PUBLIC RECORDS NOT/CE - Business information such as your company address and phone number is regarded as public information
according to the Idaho Public Records Act. Your business address and phone number may be provided to a third party upon written request.
Plumbing Contractor Authorized Signature:
Date:
Page 1 Revised 7/09/2019