HomeMy WebLinkAboutAPPLICATION & RECEIPT - 17-00333 - 35 W Main St Suite C - Apt RemodelCITY OF
MXBURG BUILDING PERMIT FORM 220
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America:[ Family community
BUILDING APPLICATION
Commercial Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number. I ' 0033 Electrical Fees Paid ❑
1. Property Owner
Name: CA¢oc/�ZSD I Q
Address: City: _Il%� � State: -TV Zip Code:
Phone: 206-3"10 220{ Email:
2. Electrical Contractor
Under Idaho B i ing Code, a registered contractor must do the work for a Co mercial Building.
Business: iz/Al &Le-cTR.lt: Sate License #: I� 7% Exp.: 8-3/-/g
Address: _ /// No-. CEUTi R City: E to State: _Z0, Zip Code: 9-3 `BYO
Phone: 2- OS .33' 976 Email:
Contact/Rep. Name: ERRY 19GlN PPhhoone�: — Email:
Electrical Contractor Authorized Signature:) 1 �— Dater • Zzi - / 7
A copy ofyour state registration/license is required to be on file. If t e first time you 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 Descripti ,,(�
Address: .3a`- I on ES7 /et4)id 70/n -L
Description of work: AL-a7v eeZ of Ups tww 444" ,t -✓T
❑ Project Cost: $ 3506. ng
• Feesfor commercial projects are charged by cost:
o First$10,000 = 2%+$60. From $10,000 to $100,000 = 1% + $260. Above $100,000 =.595 +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 195 of the remaining $5,000 = $260 + $50 = $310 total fee
• 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 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 he 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 offact 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.
Applicant's Name (print): W R I (lZ (3 OJ Signat e: Date: Vf
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
Community Development Department
35 North 1e1 East
Rexburg, ID 83440
1 Permit Technician (208) 372-2341
ty Inspection Hotline (208) 372-2344
Printed Date: 06/20/2017
- Permit Number: 17-00333
Electrical Only Commercial
- Permit Issued Date:
--, Mobile: (208)351-1970
Please contact the Building Department at (208) 372-2341 with any further questions about this receipt
***Credit card payments are accepted, but are subject to a 3% convenience fee on payment amounts over $500***
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Receipt # : 6052
Payment Date : 06/20/2017
Payment Details
FEE
ACCOUNT RECEIPT PAYMENT
CODE FEE DESCRIPTION
# CODE AMOUNT
BLDELNR@ Electrical - Non -Res or General by Cost
2832213 ELP $130.00
Total Payment Amount : $130.00
Please contact the Building Department at (208) 372-2341 with any further questions about this receipt
***Credit card payments are accepted, but are subject to a 3% convenience fee on payment amounts over $500***
Page 1 of 1