HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 16-00703 - 255 W 2nd N - 4 Plex 1CITY OF
REXBURG
Amerlurs Family Community
BUILDING PERMIT FORM 3 2
0pdated30/2016
BUILDING APPLICATION
New MFR Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number. 0`00-t ?J Electrical Fee Paid LR;
1. Property Owner
Name:om din
Address: City: C I !) c State: 1 1 Zip Code: 3`/4D
Phone: S20 — jMD Email:
Z. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Multi family Residence.
Business:FIV State License #: 0 O �'� Exp.: %1 3D b
Address: / 7� City: gey b c ° State: _Z\ Zip Code: �?3,/Ua
Phone: - ve9-7SZ) Email: a.11�^tci��ec:�rl{V)nct_c'c,�
Contact/Rep. Name: &Cin4 = zP Phone: Email:
Electrical Contractor Authorized Signature,' 1 Date: 1112
A copy ofyour state registration/license is requiredo e ortfile. l t is is the fir t timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Descriprion
Address: �-SS' W 7 hd /,il -OR- Lot #: Block #: Subdivision:
Description of work: 7wiip p6uai jide
❑ New MFR Construction: # of Buildings: # of Units:
• Fees for new construction are charged by number of buildings and number of units.
0 (130x#of1uildings)+(65x#of units) = totalfee Le. (130 x2 buildings) +(65 x 10 total units)=
$260 (buildings) +$650 (units) = $910 total fe
• There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state thatthe information herein
is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
International Cade in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): Xi Isbi Signature: lv$ eo 4 4 Date: ZZ
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