HomeMy WebLinkAboutFA APPLICATION - 17-00309 - 525 S Center St - BYUI - Austin Bldg RemodelREXBTJRG
CITY OF
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Submit By Email
BUILDING APPLICATION
Fire Alarm
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg. Idaho 83440
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Pes 'D Noeent
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ame: Nelson Fire Systems
ceress: 1481 south Major Street__ City; Salt lake city
State: UT Zip Code: 8415
Office Phone: 801-468.8300 Contact Person: Ben Nelson
Cell Phone:
6 9W Aiitihp� zed:Signature: 71A.
Date: Z
License/Registration # — Expiration: l
2. Location of Work to be Done
StreetAddress: physical Plant Way - BYU-I Austin Building City: Rexburg
State: lD Zip Code: 83440
Business Name: Mountain West Electric
Contact/Rep. Name: Dan Beck/Dana Brown Phone: 208-864-5463
EKOffice O Cel! Phone
Email: dbrown@mtnwestelec.com
Dates for work to be done: From to
3. New Construction Contracted Amount: $ 9185.60 Calculated Fee (See Below): $
13 Up to $10,000 = (total cost of system x.02) + $60 O $10,0014100,000 = ((total
cost of system -10,000) x.01) + $260
O Over $100,001= ((total cost of system -100,000) x.005) + $1,160
4. Miscellaneous
laPlan Review :=106 of Contracted Amount
C1 Re -Inspection = $65
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that 1 have read this application and state that the information herein
correctand I swear thatany lnformatlon which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the Cityof Rexburg shall
be truthful and convct. 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 penniton approval Issued under the provisions of the 2012
International Code In cases of any false statement or misrepresemm ation of fact In the application or on the pians on which the permit or approval was based Permit void if not
started within 180 days. Permit vold if workstops for 180 days.
Applicant's Name (print): Signature: � Date: %
_ . - I
Inspections must be called in before 8 AM on the day tate inspection Is requested. Inspection requests ratted in after 8 A will be scheduled for the next business day.
Inspection Hotline —(208) 372.2344 www.mburg.org Permit Technician — (208) 3722341 Revised March, 2016