HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 17-00766 - 125 Valley River Dr - Stans Paint - Tenant Improvement;; °"e°`s, CITY OF Building Safety Department
a
s o 7�nv ! City of Rexburg
lU:ABt7` BUILDING PERMIT FORM 22�
ry's^'1 35 North 15O East
an.nro;rmAur commP"'ry Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Electrical
For Office Use
Permit Numbl
Electrical Fees Paid ❑
1. Property Ower ,+/
Name: G� CYhaN
Address: City: State: Zip Code:
Phone: Email:
2. Electrical Contractor
Electrical Contractor Authorized Signature: g0w.�— Date: l 40 .9
A copy ofyour state registration/license is required t eon)ile. ffthis isthefrrsttimeyou have done work in the City ofR"burg, please provide
a photo copy ofyour heaps, Ifyou are unsure if Pour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project
Description ofwt
❑ Project Cost: $
:4
Cost of project:
Calculation for inspection fee:
Ifproject cost is between $0 to $10,000 then:
(Costafproject*295)+$60
lfprojectcost is between $10,001 to$100,o00 then:
((Cost ofpmpct-$10,000)'1%)+$260
Ifproject cost is greaterthan$100,001 than;
((Costofproject-$100,000) a i596)+$1160
There will also be a plan review fee totaling 10%of the above fee.
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpomM l hereby rerd Nat I have man this application and state her the information herein
is rorrea and I swear Nat any information which Any hereafter be given by mein hearing, before the Planningand Sorting Commission or are City Cou inl far the City of Rexburg
shallbanuumandmrrect. Iagree to comply win all Cityregulatime and State laws relating m the sublectmatter of Mis application and hereby authorized representatives more
City to enter upon Me above-mentioned property for inspections purposes. NOTE: The building ofdal may revoke permit on approval issued under the prwisiom afthe 2012
International Code in cases of any falx statement ormiarepmeentation Shut in theappli—timn or anthe plans on which the permit or approval was based. PermitvoidifnM
started within uM days. PermRvuid ifemakrtops for 180 day,
Applicant's Name (print). plot m &4' Signature: UQAA - Date: 1/
I.,,RJOns mu#be called In before SAM oa the day the inspection is repeari Inspection requnH called in after AM will he wbedulM forthe ne#b nsimms day.
Inspedion Hotline -(208] 372.2344 wwwxeburg.org Permit Technican-(208)372.2341