HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 17-00184 & 17-00185 - 359 W 4th S - The LandingC IT Y OF
REXBURG
America's 1-4mily Community
BUILDING PERMIT FO�5i�
Updated 10
BUILDING APPLICATION
New MFR Electrical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
or (if, Ice Use
Permit Number: Electrical Fee Paid ❑
1, Property O vner� qq
Name: Q"( V w S Guc,
Address: a0 I pity In rw, City: T - - State: _ Zip Code: G PY32-
Phone: 513- )? 1 `i Email:
2. Electrical Contractor
Under Idaho _/Building Code, a registered contractor must do the work for a Multi family Residence.
Business: N 4s." c"', State License #: Exp.:
Address: PD Box City: MA -%4, State: (1b ZiJ� Code: 0,9!,&
Phone: ZJ 9- 76:q Email:
Contact/Rep. Name: L.Qert ,.4s", P one: '75 -939? Email:
Electrical Contractor Authorized Signature: (/ Date:
A copy of yourstate registration/license is required to be on file. If this is the first timeyou have done work in the City of Reeburg, please provide
a photo copy ofyour licensee, If you are unsure ifyour license is on file, please check with the Permit Technician �v calling (208) 372-2341.
;. Project Description 1 'w LA,, A417
Address: 36Y k/ 9t / -OR- Lo #: _ Block #: Subdivision:
Description of work: �P ,OO,�+Sr Qo1C - I --
❑ New MFR. Construction: # of Buildings: # of Units:
• Fees for new construction are charged by number of buildings and number of units.
o (130 x # of buildings) + (65x # of units) = total fee i.e. (130 x 2 buildings) + (65 x 10 total units) _
$260 (buildings) + $650 (units) = $910 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
is 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 of this application and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official7ayvoke 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 thon which the permit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
7
Applicant's Name (print): "d 'vim Signature:
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