HomeMy WebLinkAboutAPPLICATION FIRE SPRINKLER - 17-00272 - 639 Handcart Ln - Savoye Apartments LLCCITY OF
REXBURG
America's Family Community
BUILDING PERMIT FORM 4�2
Updated 10/2016
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Sprinkler
For Office Use
Permit Number: Fire Sprinkler Fees Paid ❑
1. Property Owner
Name: a V e 2 CLACK Is
Address:—I( ( City. b kr State: Td Zip Code: 4 4 6
Phone:Email:
2. Contractor
Business: e IC. State License #: IS&CI4 Exp.:
Address: r S' City: 42r, d, State: L Zip Code: 5,3(Q,1a
Phone: Email: �p ; S 6v"rQ rj w�
Contact/Rep. Name: !-'ta �L n,D L e Jas Phon -,� �jEmail:Q gyp,,
Contractor Authorized Signature: Date:
A copy ofyour state registration/license is re "-e o e o le. If this is the first time you have done work in the City of Rexburg, please provide
a photo copy of your license. Ifyou are u s e ifyour ice e is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: !WS 5 )-IA-„,, cJ CO_V,� J_ r,
Description of work: (2POr
t
Number of Heads: 17-3 �} c
❑ Fire Sprinkler System Cost: $ C� I V
• Fees for 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 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, I hereby certify that I have read this application and state that the information herein
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 ofthis 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 ap�proval 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 tyh ermit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days. ��//
Applicant's Name (print): L ` 0.� ,Lp ,�r Signature:
Date: /
Inspections must be called in before 8 AM on the day the inspection is requestedAd'in
.spect requests ca11after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.re bur rg Permit Technician - (208) 372.2341