HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 16-00579 - Gorilla Performance New BuildingCITY OF
REXBURG
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AmerlwI, Family Community
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BUILDING PERMIT FORM 220
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BUILDING APPLICATION
Commercial Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number:—)— �l 005 7-I!�
Electrical Fees Paid ❑
1. Property Owne
Name: Or a— aroryn ix�cc,,
Address: >✓% City: 9' ,^j�,t- State: ���'//,, Zip Code: 83 Yd
Phone: Emai .
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: State License#: e—lg3�K Exp.: 5-30 /S,
Address:%%� E City: State: ,� Zip Code: ' i�
Phone: 2pa- :9542-3-770 Email:
Contact/Rep. Name: 719APhone: --I 33 Email://7��C''�
Electrical Contractor Authorized Signatur . �� ®ut Date: ��77
A copy ofyour state registration/license is r qufred to be on file. f this is the 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 Description
Address: 'hCfit% t BrLC��I (/T
Description of work:
❑ Project Cost: $ 4A212
• Feesfor commercial projects are charged by cost:
o First $10,000 = 2%+ $60. From $10,000 to $100,000 =146 + $260. Above $100,000 =.5% +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first$10,000 and 146 of the remaining $5,000 = $260+ $50 = $310 total,
• There will also be a plan review fee totaling 1095 of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, l hereby certify that l have read this application and state thatthe information herein
is correct and 1 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 ofthe
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 ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifnot
started within 100 days. Permit void if work stops for 180 days.
Applicant's Name (prnature:
'�cd0 r
,8ro/k,/ 1 --el' /1 kraHDate: /v-/6-/7
Inspections must he 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