HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 17-00097 - 415 W 6th S - Falls Pointe Apt - 42 Unitsc l'rT or
REXBURG
Americus rarnity Community
BUILDING PERMIT FORM 320
Updv,,10/2016
BUILDING APPLICATION
New MFR Electrical
Building Safety Department
City of Rexburg
35 North 1s1 East
Rexburg, Idaho 83440
For Office Use
Permit Number: 17 —moo a 9 7 Electrical Fee Paid ❑
1.Properl)wr(n,
Name: T Q �lS �d11' I- to
Ad49 Lf City: Wb b 7:6i1 S_ State: )P Zip Code: �Q 3
Phone:41LA•3(oD -`f(Of Email: eh kom QieCO
Z. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Multi family Residence.
Business:— Irl 7 1Z State License Exp.:
Address: 27i A4 1g 2a" E'as f City: AK Stat Lip )de: — -j62
Phone: ZQj j) 3 - ZJ 13 Email:
Contact/Rep. Name: Phone: _ // Email:
Electrical Contractor Authorized Signature: .4V4104" -Date:ZK4)
A copy of your.state registration/license is required to be reef f le.11 thie isthe ]list time 3iou have done work in the Cily ol'Rerburq, please provide
u photo copy of your license. If you are unsure if your license is on file, please check with the Permit Technician by col t ing (208) 372-2341.
3. Project Description t
Address: �i� W. II _,.k Sr -OR- Lot #: _ Block M _ Subdivision:
Description of work:
New M FR Construction: # of Buildings: _� q of Units:
• Fees for new construction are charged by number of buildings and number of units.
o (130x#ofbuildings)+(65x#of units)=totalfee i.e.(130x2 buildings)+(65x 10 total units)=
$260 (buildings) + $6.50 (units) =1210 total (ee
• There will also be a plan review fee totaling 10% of the above fee.
APPLICANrs 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 be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and herebyauthorized representatives ofthe
City to enter upon the above-mentioned property for inspections purposes. NOPE: 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 `U.1 Xit' 1 V�S<ignature: Date:
Inspections trust be called in before 8 AM an 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