HomeMy WebLinkAboutAPPLICATION - 17-00368 - Rocky Ridge Apartments - Temp Powery.wF•Y°�� CITY OF Building Safety Department
J, REXBURG BUILDING PERMIT FORM 2 City of Rexburg
Updated 10/2016 35 North 1St East
America, Fa nils CornnntnuV Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Electrical
o;� Office Use
Permit Number: Electrical Fees Paid ❑
1. Property Owner
Name:
Address: 2— City: /"�7467%-Oss — Stater • Zip Code
Phone: 01,y-3 — 3U7 cl Email: —
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: State License #: 1511rEr Exp.:
Address: City: , p
I?2�� State• Zi Code:
Phone: Zff - f Email: %%6 =! & 6-1 —e MCI
Contact/Rep. Name: Phone: Email:
Electrical Contractor Authorized Si natu e: Date: 7
A copy ofyour state registration/license s required to be n file• If this is the first time you have done work in the City of Rexb rrs g, ple se provide
a photo copy ofyour license. Ifyou are unsure
if,
lice se is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Descripti on
Address:
Description of work:
❑ Project Cost: $
• Fees for commercial projects are charged by cost:
o First $10,000 = 2% + $60. From $10,000 to $100,000 =1 % + $260. Above $100,000 =.5910 +$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 = $310 total fee
• There will also be a plan review fee totaling 10916 of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 1 hereby certify that Ihave read this application and state that the information herein
is correct and I swear that any information which may hereafter be given by mein 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. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print):/W�_Yl SignatuDate:.
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