HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 17-00362 - DL Evans Bank - Tenant Finish9(
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u; a� CITY OF
° REXBURG BUILDING PERMITFORM 22U
(Wupa.i 10/2016
Amerloas Family Community
BUILDING APPLICATION
Commercial Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexhuru_ Irinhn R2dAA
For Office Use
Permit Number: 'W 361 Electrical Fees Paid
I. Property Owner
Name:
Address: City: State: Zip Code:
Phone: Email:
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: ;t - C, I Sh� /rlV;CC
QP tii �_$ State License #: Exp.:
Address: X05 % hrn! %40G Yl/o City $ �tdll . State: 'Ltd Zip Code: %
Phone: Email:
Contact/Rep. Name: ��Phon/�e: Email: y(
Electrical Contractor Authorized Signature:�� Date: rfL%
A copy ofyour state registration/license is required to be on file. If this is the first timey-5uhave 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: JJ=S Va 111y F—`— h
Description of work: _l tf�+ T� f(�,.v,,+
❑ Project Cost: $ kU'IYD
• Fees far commercial projects are charged by cost:
0 First$10,000 =2% + $60, From $10,000 to$100,000=1%+$260. Above $100,000 =.5% +$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 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l have read this application and state that the information herein
is correct and 1 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. 1 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 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. Permitvoid ifwork stops fo 180 days.
/Applicant's Name (prin
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 - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341