HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 18-00528 - 859 S Yellowstone Hwy - Dr Coray Office - New BuildingOQ RiX B URC
�p 7 C I TY OF Building Safety Department
U � 0
RE
T m
1Ey 1tG BUILDING PERMIT FORM 2 2 City of Rexburg
(yu Updated l0/2016 '•< 35 North 1St East , America's Family Community
1NfD
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Electrical
For Office Use
Permit Number: (5 - OlK Electrical Fees Paid ❑
1. Property0�"'ner
Name: 11<C�
r,r n
Address: City: State: Zip Code:
Phone: Email:
2. Electrical Contractor
Under Idaho Bui ing Code, a reg'
istere contractor must do the work fora Commerci Building.
Business: r State License #: --c-1 jZi ( Ex
Address: � �"(- p"
City: State:— ZipCode:
Phone 3-), c; �; —) Email:
Contact/Rep. Name: Phone: Email:
Electrical Contractor Authorized Signature: Date:
A copy of your state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure if your license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address:
Description of work:
❑ Project Cost: $
• 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, 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 me in 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.
4LLApplicant's Name (print): k ° nature: ate:
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