HomeMy WebLinkAboutAPPLICATION FIRE ALARM (REVISIONS) - 17-00097 - 415 W 6th S - Falls Pointe Apt - 42 Unitscepe%a°"� C IT v OF Building Safety Department
CBUILDING PERMIT FORM 4 1 City of Rexburg
—CW u�."° " 35 North 1st East
Amrrtra}rnmdlyCmnmunily - Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Alarm
For Office Use
Permit Number:7-e.mo 4'7 Fire Alarm Fees Paid ❑
I. Proper Owncr
Name: IIS 1i✓1�(� LLL >
Address: i2z,QiOX IL4q City: (ffQQ$�lt�l.S State:�-(��-ZipCode: J
Phone: �;o$'31Q0 "'t -41P13 Email: Ill I- IIS? W Q��%YlOt�rcUb✓�
2. Contractor -,,ls
Business: r/' -State License li: e-Zf41g1j Exp.:
Address: City: State: Zip Code: X*j,,_
Phone: ZL -711-T
� Email_
Contact/Rep. Name: _ Phone:. Email::
Contractor Authorized Signature: -yk el� Date: _ -44_--/ z, /%
A copy ofyourstate registration/Ifcense is required In be an file. 11 this m Ole first time you have (lone work in the City of Rexburg, please provide
it photo copy ofyour license. Ifyou rare unsure ifyour license is on fie, please check with the Permit'I'e(hincian by calling (208) 372-2341.
3. Project Description .JC1Kl�„
Address: �{'�� ��. �O
Description of work:
❑ Fire Alarm System Cost: $ _
• Feesforfre alarmsystemsare charge bycost.
o First$10,000 = 2% + $60. Frorn$10,000 to $100,000 = 1% + $260. Above $100,000 =.5% +$1,160. i.e. Work costfgq
$15,000 will be charged $260 for the first $10,000 mrd 1% of the remaining $5,000 = $260 + $50 =L310 total fee
• There will also be a plan review fee totaling 10% of the above fee.
.APPLICANT'S SIGNATURE, CERTIFICATION ANOAUTUORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information herein
eorrect and I swear that any Information which may hereafter be given by me in hearings before Cm 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 Cade 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 wilhln 180 days. Permit void If work stops for 180 days.
Applicant's Name (print): �LN 7 ISYgnature:
�� Date:
Inspections must be called In before RAM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Nadine- (208) 372.2344 www.rexburitorg Permit Technician - (200) 372.2341