HomeMy WebLinkAboutAPPLICATION & PLAN - 06-00499 - Zions Bank - Electrical(17Y OF KEXB URG , 0 PERMIT #
BUILDING PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
Is based on the lntormatlon - must be accurate
CONTACT PHONE # ZL-V 9 S -
PROPERTY ADDRESS:
PHONE #: Home ( ) _ Work ( ) ` 5`- - _ - MS Cell( )
OWNER MAILING ADDRESS: SALA_ CITY: r- -- -- -- ST ATE - ° - �� - J UP - ----
EMAIL FAX 3 Sfo — `Z 669 0V1 -
APPLICANT (If other than owner) kjb(z � IA
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 5TK. -er CITY:
STATE; ZIP -EMAIL r,rict�tt�.eto(aet�afeo
PHONE #: Home ( ) Work ( ) t�0 -?�i '(.eIl�(
CONTRACTOR
MAILING ADD// RESS: 2y,"D - i5 `T �s`1� CITY w��S STATE � ZIP �3 d
PHONE: Cell# - 2GU-3$oc - � Work # _ &�Lf,S�2- `�Cfl�S Fax# �"Z °
EMAIL tA9t<tn+.�,*60 IDAHO REGISTRATION # & EXP. DATE We-,C- ' '2�-
P A?6T
How many buildings are located on this property? EnQEEE; Q
Did you recently purchase this proper No es (If yes give owner's name) 2
Is this a lot sp t. NO Y_ES (Please bring copy of new legal description of property)
PROPOSED USE: "V ey - �P E 1
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt ofperjur I hereb certif 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 2003 International Code in cases of any false statement or misrepresentation of fact
in the applicati 4or on the pl whi ch the perrit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
of Owner /
DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning Tanuatxl. 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application** * *Building Permits are void if your check does not clear**
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Building Safety Department
City of Rexburg
19 E Main jonellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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C I T Y O F
REXBURG
America's Family Community
OWNER'S NAME Z ions
PROPERTY ADDRESS
SUBDIVISION
PHASE LOT BLOCK
0600499
Zions Bank - Electrical Only
Required!1 l
ELECTRICAL
Electrical Contractor's Name .J ^lC & Dk Z74-1 Business Name IC,Z21 (:� cc 77ez<
Address "01 �, W,� City State Zip
Cell Phone (7f 5`97 3� Business Phone (763) 7.'Q_5: �
Fax (2 79 - G - Email 6',V Q A Qb kz� 4�4�2&n D /12 u.Pi N
Electrical Estimate ( cost of wiring & labor) $ (COMMERCIAL /MULTI - FAMILY ONLY)
TYPES OFINSTALLATION(RESIDENTIAL)
(New Residential includes everything contained within the residential structure and attached garage at the same time)
Up to 200 amp Service*
201 to 400 amp Service*
Over 400 amp Service*
Construction Service, 200 amp or less, one location (for a period not to exceed 1 year)
Spa, Hot Tub, Swimming Pool
Electric Central Systems Heating and /or Cooling (when not part of a new residential construction permit
and no additional wiring)
Modular, Manufactured or Mobile Home
_ Other Installations: Wiring not spe gfically covered by any of the above
Cost of Wiring &Labor: $
1 60
Pumps (Domestic Water, Irrigation, Sewage)
Requested Inspections (of existing wiring)
Temporary Amusement /Industry
*Includes a maximum of 3 inspections. Additional inspect
charged at requested inspection rate of $40 per hour
OC �O 16 (r7
Signature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State
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