HomeMy WebLinkAboutAPPLICATION - 17-00072 - 593 S Hidden Valley Rd - Basement Finish;o yBXBURp e n CITY Y OF
REXBURG BUILDING PERMITFORM 123
(W a,daud 10/2016
America's Family Community
BUILDING APPLICATION
SFR Basement Finish Electrical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Electrical Fee Paid
1. Propert�Owner
Name: %T t;. %lM4ot
Address: S13 S- Na(r I/a/r City: RlOyg(i V State: 'C 6 Zip Code:
Phone: 00 .SSI—.SS8y Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home. I rtv fd lwu .f IFfharb (2arP)
Are you a homeowner doing work on your own home?
Byes (Skip to #3 and complete the Homeowner's Exemption)
❑ No, l am working with the homeowner
2. Electrical Contractor
Business: State License #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
Electrical Contractor Authorized Signature: Date:
-
A copy ofyour state registrationflicense is required to be on file. If this is the first timeyou have done work in the CityofRexburg, please provide
a photo copy ofyour license. if you are unsure ifyour license Is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description ////
Address: S2?3 S' �1Ya &1141V /t,4
Description of work: seFc7t / elr[fr/'cad
❑ SFR Construction: /?50 sq. ft
• Fees for basement finishes are charged bysquare footage: Up to 1,500 sq. ft. = $130 + $65 for each additional 1,000 sq. ft. or
portion thereof.
o Up to 1,500 sq. ft. = $130. Up to 2,500 sq. ft. = $195. Up to 3,500 sq. ft. = $260. Up to 4,500 sq. ft. = $325, etc. (i.e. a
home with 3,675 sq. ft will be charged $325)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that have read this application and state that the information herein
is correct and I swear that any information which may hereafter he 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 withal] 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 ifwork stops for 180 days.
Applicant's Name (print): fPd(.Y mAh Signature: G G'e'" "" Date:
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 - (2 OB) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341