HomeMy WebLinkAboutAPPLICATION FIRE ALARM - 17-00362 - DL Evans Bank - Tenant FinishCITY OF
REXBURG
Americas Family Community
BUILDING PERMIT FORM4 01
c'damd 1012016
BUILDING APPLICATION
Fire Alarm
Building Safety Department
City of Rexburg
35 North 11t East
Rexburg, Idaho 83440
For Office Use
Permit Number: M - 003(o?_ Fire Alarm Fees Paid ❑
1. Property Owner
Name: ot_ EvAfj!% QQIJIc
Address: Po Ux 1%88 City: State: Ih Zip Code: 0131 8
Phone: We) .1S1a4 - B14i5aJ Email: 3A ,y11-49 Q &AAel6 a o,
2. Contractor
Business: r�Pjrfto&ftnro S+LwMoNS en&ArANlf State License#: RCE15117,1 Exp.: (PI321f,
Address: zseu w'" M City: A,n 011 State: Ib Zip Code: caa.Voa
Phone: 62o9) 313-202U Email: .SIN. 0 CSu a. CoA
Contact/Rep. Name: Kot.BV MAW,o2_ qPhone: taws) e11 -412,a Email: "Lw e 69 un. coe
Contractor Authorized Signature: //Wl l�/�r� Date: c9 -/16 l 7
A copy ofyour state registration/license i�' ed to be on file. If 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: 17_!a vnur.6? QIVER2D IVr
Description of work: OsM0Ag1,
❑ Fire Alarm System Cost: $ <6000
• Fees far fire alarm systems are charge 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
• There will also be a plan review fee totaling 10% of the above fee.
.APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state that the information herein
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
he 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 ofthe 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): 9(T(,RY M49 -wt- Signature: ^ Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will he scheduled for the next business day.
Inspection Hotline- (2 08) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341