HomeMy WebLinkAboutAPPLICATION FIRE ALARM - 17-00800 - 60 S 5th W - Kennedy Elementary AdditionCITY OF
REXBURG
to
Americil rvin ly Cnntinutrity
BUILDING PERMIT FORM4 01
apaouelo/ears
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: 144 svvt 5e 6:l NA 9 321 f
Address: ZRo N. I Sr E City: �hrt.16u State: _t 1�> Zip Code: 9'3 ` VC'
Phone: Email:
2. Contractor
Business: 3ol,Nhsna Cr Awk FP State License lf: 9-C15-155-20 Exp.: yll i �l9
Address: k7Ui Nl, HALkew~� Dr City: Boise. State: t Zip Code: 8370!
Phone: Zvg- 374.- 7-1/1 Email:
Contact/Rep. Name: S6vvn4E_ Le-StZ6_c Phone; Zdd-513-38 t9 Email: .SA4He_LeSfebe//ry SCY<cb�
Contractor Authorized Signature: c—' Date: �/o(itl
A copy ofyour.stfte registration/license is require to re an file. if this is theFrst time you have done work in the Ciq, ofRexhurg, please provide
a photocopy ofyour license. Ifyou rine unsure ifyour license is on file, please check with the Permit Technician by calling (200) 372-2341.
3. Project Description
Address: 60 S 6__/'h IJ
Description of work PAOU4K s� ✓ ca qtr r S� 5 �
❑ Fire Alarm System Cost: $?, 3S` g-
, CSO
• Pees forfrre alarm systems are charge by cost:
o First$10,000=245+$60. From $10,000 to .$100,000=1%+$260. Above$100,000 =.5% +$1,160. i.e. Work costing
$I5, 000 will be charged $260 for the first $10,000 and 1916 of the remaining $5,000 = $260 + $50 = 2310 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 1 have read this application and state that the information herein
correct and I swear that any Information which may Iremaftm he given by me In hearings before the Planning and Zoning Commission or the City Council for tire 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 tire City
to enter upon the above-mentioned property for inspections purposes. NOTE: The buildingofficial may revoke a permit on approval Issued under the provisions of the ZO1Z
International Code In cases of any false statement or misrepresentation offset in the application or on the plans on which the permit or approval was based. Permit void If not
started within 180 days. Pei mitvoid if work stops for 180 days.
Applicant's Name (print): 'E-)VOOL LAS � rel Signature: _� / Date: 40119
Inspections must be called In before SAM on the day the inspection is requested. Inspection requests called In after HAM will be scheduled for the next business day.
Inspection Hodine — (208) 372.2344 www.rexhurg.org PermitTechniclao — (208) 372.2341