HomeMy WebLinkAboutAPPLICATION FIRE ALARM - 17-00798 - 2211 W 1000 S - Burton Elementary AdditionCITY OF
REXBURG
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America; Gamily Cmtnnunily
BUILDING PERMIT FORM 401
np&W 10(2016
BUILDING APPLICATION
Fire Alarm
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Fire Alarm Fees Paid ❑
1. Property Owner
Name: 1,1&Ai s vI 5'c-k,LA Nst # 521
Address: ?9 d N, l s� E City: �e�t% r.. rit State: �_ Zip Code: OL/IC)
Phone: Email:
2. Contractor
Business: J4wistaA 0s,6-ok FP State License#: Exp.: `Milli
Address: k'-2�.3 VJ, He,il-ezg~e br City: Poise State: I D Zip Code: s33'769
Phone: Email:
Contact/Rep. Name: S inyw_ Le-sfe6_r6 Phone: 24-6ti33919 Email: Le4-2SC,Yr Covin
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Contractor Authorized Signature: ��— � Date: oG/!V
Acopy ofyour.stateregistration/licenseisrequire(a)eonfle.Ifthis isthefirsttimeyouhave done wm*inthe City ofReeburg,please provide
a photocopy ofyour license. (fyou are unsure ifyour license is on file, please check with the permit Technician by calling (208) 372-2.341.
3. Project Description
Address; 7-7-11 W.10005 rr
Description of work: M4Ftae��ard� sCz,�
❑ Fire Alarm System Cost: $ 151 S.D
• Fees for fire alarm systems are charge by cost:
o First$10,000 =A + $60. From $10,000 to $10,000 = 1% + $260. Above $100,000 =.5% +$1,160. Le. Work costing
$15,000 will be charged $260 for the first $l 0,000 and 1% of the remaining $5,000 = $260 + $50 =.$310 total fie
• There will also be a plan review fee totaling 1045 of the above fee,
.APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofper)ury, I hereby certify that l have read thisapplication and state that the Information herein
correctand I swear that any Information which may hereafter be given by me in hearings before the Planning and ZontngCommisslon or the City Council for the City of Rexburgshall
be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and het'ehy authorized representatives of the City
to enter upon the above-mentioned property for Inspections purposes. NOTE: The building official may revolce a permit on approval Issued under the provisions of the 2012
International Code In cases ofany false statement or misrepresentation of fact In the application or on the plans on which the permit or approval was based. Permltvuidlfnot
started within 180 days. Permit void It work stops for 180 days.
Applicant's Name (print): �I n n2 L �ST�bP4i Signature: Date:
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 - (288) 372.2344 www.rexburgorg Permit Technician - (208) 372.2341