HomeMy WebLinkAboutAPPLICATION - 19-00185 - 328 N 2nd E - Karie Anne's - Electrical Service OnlyCITY O F
REXBURG
America's Family Community
For Office Use Ute -
Permit Number: 1 Gi -yc t 6
BUILDING PERMIT FORM ZZO
Updated 03/2018
BUILDING APPLICATION
New Commercial Electrical
1. Property caner
Name: j QvWq6,
Address: City:
Phone: 2- - OC) [
2. Electrical Contractor
Email:
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
Electrical Fees Paid ❑
State: _ Zip Code:
Under Idaho quilding Code, a regist red contractor must do the work for a Commercial Building
Business: � 17�r- !fit} C_ _- State License #: �KS ZL5 Exp.:
Address: City: State: Zip Code:
Phone: Email: #'i ,
Contact/Rep. Name: tG 2 ho e: Email: �j
Electrical Contractor Authorized Signature: Date: '1 1
A copy ofyour 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 ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description, I
Address: S U �t 2`f T
Description of work: (�?c ^d1 > (�t} � G � 1 l
4 All`
❑ Project Cost: $ d
Cost of project:
Calculation for inspection fee:
If project cost is between $0 to $10,000 then:
(Cost of project * 2%) + $60
If project cost is between $10,001 to $100,000 then:
((Cost of project - $10,000) *19,o) + $260
If project cost is greater than $100,001 then:
((Cost of project - $100,000) * 1/z%) + $1160
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 1 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.
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Applicant's Name (print): L-sL,__4117c�'%ignature:'t%/\ L D
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