HomeMy WebLinkAboutAPPLICATION 3 - 18-00310 -1450 N 2nd E - Walmart - Fitting Room/Photo Lab RemodelC I TY OF
REXBURG
America's Family Community
BUILDING PERMIT FORM 220
updated in/zine
BUILDING APPLICATION
Commercial Electrical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use p
Permit Number: OyElectrical Fees Paid ❑
1. Property Owner
Name: Wal Mart Real Estate Business Trust
Address: 2001 SE 10th St Cin,: Bentonville State: AR Zip Code: 72712
Phone: 479-273-4000 Email:
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: Nelson Electric State License #: ELE-C-38127 Exp.: 11/30/2018
Address: 3896 E. 600 N Cin,, Rigby State: ID Zip Code: 83402
Phone: 208-754-9389 Email: karren@nelson-electricllc.com
Contact/Rep. Name: Karren Nelson Phone: 208-754-9389 Email: karren@nelson-electricllc.com
Electrical Contractor Authorized Signature.Date: 8/23/2018
A copy ofyour state registration/license is required to b on file. If this is the first time you have done work in the City of Rexburg, please provide
a photocopy 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: 1450 N 2nd E. Rexburg, ID 83440
Description of work: Store Enhancement
El Project Cost: $ 5,870.00
• Fees for commercial projects are charged by cost:
o First $10,000 =2% + $60. From $10,000 to $100,000 =1 % + $260. Above $100, 000 =.5% +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 =$310 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, 1 hereby certify that 1 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.
Applicant's Name (print):��r/V Pi SignatuDate:
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 nextbusiness day.
Inspection Hotline- (208) 372.2344 www.rexburg.org Permit Technician- (208) 372.2341