HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 18-00519 - 1336 Stone Dr - Basement FinishCITY OF
REXBURG
America's Family Community
For Office Use
Permit Number: t b'Ex051'A
BUILDING PERMIT FORM a�jl
Updated 03/2018
BUILDING APPLICATION
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
eElectrical Fee Paid
1. Property Owner _
Name: RK2 SAS
Address: kl 3 o -j E X�' Q City: x 3v State: t7 Zip Code
Phone: L� �� 1 `Z-'j� 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 473 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Electrical Co tractor/
Business: V .LZ (C �Pufc_ State License #:
Address: City:
Phone:
Contact/Rep. Name:
Email:
Exp.:
State: Zip Code:
Email:
_b54 qv
Electrical Contractor Authorized Signature: A ✓7 � Date:
A copy ofyourstate registration/license is required to b n file. If thi s 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:
Description of work:
❑ SFR Construction:
sq. ft
Fees for additions are charged by square footage: Up to 1,500 sq. ft. = $130 + $65for each additional 1,000 sq. ft or portion
thereof.
Square Footage
Total Cost
Up to 1,500 sq. ft
$130
Up to 2,500 sq. ft
$195
Up to 3,500 sq. ft
$260
Up to 4500 sq. ft
$325
Add $65 per additional thousand sq. ft
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 mein hearings before the Planning and Zoning Commission or the City Council for the 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 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.
Applicant's Name (print):
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 - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341