HomeMy WebLinkAboutAPPLICATION - 17-00788 - 830 S 5th W - Basement WiringCITY OF
REXBURG
CW
Americas Family Cummlmily
BUILDING PERMIT FORM 12 3
Up&WIO/2016
BUILDING APPLICATION
SFR Basement Finish Electrical
Building Safety Department
City of Rexburg
35 North 15C East
Rexburg, Idaho 83440
For Office Use
Permit Number: 13 -67 51?2 A Electrical Fee Pal
1. Property Owner
Name: Z)ALG W$ ,5 OAJ
Address: 936 SnvG a .9_Tq W Ftt' City: C &"ieQ State: 10 Zip Code: 9541VO
Phone: 20 A- 703 - SibG Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
lo, I am working with the homeowner
2. Electrical Contractor
Business: WC -1: g 6c1fx , State License #: Exp.: L -.30 -/$
Address: 103 406&CtAn City: 'PA YeSOd State:tt lit Zip Code: ig"/6S /
Phone: - - JW_Z Email: 4h&a I:Y F ZM70 i�E, t'o Al
Contact/Rep. Name:6 __ Phone: APA : P Email: !PW6Rd'iL7L7S6P 6'MA14,,Caen
Electrical Contractor Authorized Signature: Date:
-
A copy ofyour state registration/license is required to be on file. If this is the first timeyou 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: $.30 5 1-414 (A ar
Description of work: 26m -i- W 66&
❑ SFR Construction: L00 sq. ft.
Fees for basement finishes are charged by square footage: Up to 1,500 sq. ft. = $130 + $65 for each additional 1,000 sq. A or
portion thereof.
o Up to 1,500 sq. ft. = $130. Up to 2,500 sq. ft. = $195. Up to 3,500 sq. ft = $230. Up to 4,500 sq. ft. = $295, etc. (i.e. a home
with 3,675sq. fG will be charged $295)
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. 1 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 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.
/I
Applicant's Name (print): LOW r- Signature: Date: 12-ZO -17
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 - (2 08) 372.2341