HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 16-00704 - 255 W 2nd N - 4 Plex 2F;�e�uURC,>
CITY OF
REXBURG
Americas Family Communify
BUILDING PERMIT FORM 3 2
upaav:e zo/zozs
BUILDING APPLICATION
New MFR Electrical
Building Safety Department
City of Rexburg
35 North 15t East
Rexburg, Idaho 83440
For Office Use
Permit Number: -00 Electrical Fee Paid
1. Property Owner
Name: "1_ 14 11I
Address: City: State: Zip Code:
Phone: Email:
2. Electrical Contractor
UnderIdaho Building Code, a registered contractor must do the workfor a Multi family Residence.
Business: �_IIL IZtAeo C1,0&f, lt, State License #:`e2l7y0y Exp.:111-,01/2
Address: 13195W SSo65 City: L&413ura State: TD Zip Code: $3
Phone:'ZOLn-190-7JnZ EInai: 4-1KrtilliIeeieciric(2 ma.LC•com
Contact/Rep. Name: QtYodn u Pho Email:
Electrical Contractor Authorized Signature:, Date: /7
A copy ofyour state registration/license is required o be o file. this is he first timeyou have done work in the City of Rexbu g, please provide
a photocopy ofyour license. Ifyou are unsure ifyou icense is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: 7-SI 1-) hoi /l -OR Lo
Lot #: _ Block #: _ Subdivision:
Description of work: EPCirti�/L1PL.J Cox;
❑ New MFR Construction: # of Buildings: -7 # of Units: _�_- & uh;+5
• Fees for new construction are charged by number of buildings and number of units.
o (130x#of buildings)+(65x#of units)=totalfee i.e. (130 x2 buildings)+(65x10 total units)=
$260 (buildings) +$650 (units) = $910 total fee
There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHO RIZATION: Under penalty of perjury, I hereby certify that l 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. Permitvoidifnot
started within 180 days. Permit void if work stops for 180 days.
r1
Applicant's Name (print): Signature: Dater
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
a"'