HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 17-00634 - 1480 N 2nd E Suite 110 - Sally Beauty - Tenant Finish - Occupancy Permit1)
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BUILDING PERMIT FORM
Updated 10/201
220
BUILDING APPLICATION
Commercial Electrical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office [T
Permit Number: Electrical Fees Paid El
Propertv Owner
Name: i �...v�� t,f� ��lY1�f�.i l S
Address: J 1 � `� � L�c.i_.L �� Lek.'� � �'�': �r��
city: ���`_�(= � 1� � C t�,v State: .: Zip Code:.����
Phone: Email:
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building,
Business: � 1� �1�7�i i r_zt\1 I :Lt,�c i��ic:, i)'�s�., State License #: � � � � 2 `" `- Exp.:
Address: [ � �? } ��t�
C ity:J...- ftuL-;ji,l.'} State: T-7) Zip Code: `••5 5` �'L. �
� AL
�� - � � �1 Z , Email: " ': i'� _=�`+ IAC _ L
Phone:
Contact/Rep. Name: ' ' L7 � `�f�l'�"�`�i ne Email:
Electrical Contractor Authorized Signature: �'�"�Y � � � � ''�1 y7Z r�= �>- `�A Date:
A copy of your state registration/license is required to be an file. /f this is thefirst timeyou 1done 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 T)ej�'ription
Address: l "i� � V` �! , ..� � � � �(.(_, I
Description of work: r C'.14' t ti j r �N ►S�
�roject Cost: $ ;� � Oct..
0 Feesfor commercial projects are charged by cost.-
0
ost:o First $1 0, 000 = 2 % + $60. From $10, 000 to $100
o,000 = 1 Vo + $260. Above $10.0,000 -.5% +$1,160. i.e. Work costing
$15, 000 will be charged $26 0 for the first .$10, 000 and 1 % of the remaining $5, 000 = $2 6 0 + $50 = $310 to tal,Lee
There will also be a plan review fee totaling 10910 of the abovefee.
APPLICANT'S SIGNATURE, CERTIFICATIO-N AND AUTHORI2ATIDN: Under penalty of perjury, l 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 honing Commission or the City Council for the City of Rexburg
shad be truthful and correct. t agree to comply with all City regulations and Stats laws rebating to the subject matter of this application and hereby authorised representatives of the
City to enter upon the above-mentioned property fort'nspections purposes. NATE: 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.. Permit void if work stops for 180 days.
Applicant's Name (print):
Fi
Y
nature.
AP 0
Date: �
Inspections must
be called in before 8 AM on the day the inspection is
requested. inspection
requests coiled in after S AM will be scheduled for the next business
day.
Inspection Hotline
- (208)
372.2344
www.rexburg.arg
Permit Technician - (208)
372,2341