HomeMy WebLinkAboutAPPLICATION FIRE ALARM - 16-00478-482 - Campus Courtyard 2CITY OF
REXBURG
CW-
AmeNca's Family Community
BUILDING PERMIT FORM 4 1
Updated 1012016
BUILDING APPLICATION
Fire Alarm
Building Safety Department
City of Rexburg
35 North 15L East
Rexburg, Idaho 83440
For Office Use
Permit Number: Fire Alarm Fees Paid ❑
1. Property Owner
Name: 3AC44 SOrtnwitt-t2 Wac-9Vi j n
Address: 328'111 3000 W City: QuwlovrG State: "ZO Zip Code: 83440
Phone: tPV9-109-44184 Email:
2. Contractor CoBusiness: P�fe NkCtr, t CV die -State License #: Exp.:
Address: .>?` li fl 3. Nol Vtne g t2_ City; fn t t� r"�V \1S State: a-1/> Zip Code:
Phone: 9019`57-4-47-82- Email:ktvtn o� Pe�gtu4la,.w, , C.uv%-
Contact/Rep. Name: Phone: a'108'5-A-ba07 Email: k1;k ZpcAv- (ayn l •Cts,,
Contractor Authorized Signature: _ Date: -51-21-911-7
A copy ofyour state registration/license is required to be on file. If this is the first timeyou 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) 372-2341.
3. Project Description CAvvtpv 5 C-Ovr1new -
Address: 00 9 S. 51 W csT 'P=A jql -1-g
Description of work: 'Z✓ts-rv2A1 V--li .4 pldnrw, w PEAte {-o d0 fit, a; W tiravC\Ip✓fej+gf»"'1?
❑ Fire Alarm System Cost: $ i . 1o00 1e l a f^ U t
• Fees for fire alarm systems are charge by cost:
0 First $10,000 = 2% + $60. From $10,000 to $100,000 = 1% + $260. Above $100,000 =.5% +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = 5310 total fee
• There will also be a plan review fee totaling 10% of the above fee.
.APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information herein
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 afthe 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. Permit void ifnot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print):i
M�j S+- o�
Signature:
Date: 5 as l7
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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