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Home My WebLink AboutALL DOCS - 14-00324 - 311 S 1st W - Hart Bldg - Hart 141 Dance Floor Remodelct-tY oF REXBURG Please Complete the Entire Application! If the question does not apply fill in NA for non applicabie PARCE,L NUMBER: SUBDI\{SION: - c\t \ me ricak Fa mil S: Co m n un ity COMMERCIAL & MULTI FAMILY BUILDING PERMIT APPLICATION 35 N 1" E, REXBURG,ID 83440 208-372-2326 We will provide this for you) UNIT# BLOCK# LOT# How many buildings are located on this property? Did you recently purchase this propertyl / NO (If yes, list previous Is this a lot split? f PROPOSED USE: (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Gange, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenaltyof perjwy,Iherebycerriftthatl have read this application and state that the information herein is conect and I swer that any information which may hereafter be given by me in hemings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and conect. 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 offrcial may permit on approval issued under the provisions of the 2003 Intemational Code in cases of any false statement or misrepresentation of fact in thexor:ilratix.or on the which the permit or approval was based. Pemit void if not strted within 180 days. Pemit E YES ownef's name) NO E YES @lease bring copy of new legal description of properry) void ifwork stoos for 180 davs. n laslzot4 DA?E J by fax, email or phone? WARNING.BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! Plan fees are non-rcfundable md are paid in full at the time of application beginfing lplryJ-&5 City ofRexburg's Acceptance ofthe plan review fee does not constitute plan apPrcval (Addressins is based on the infotmation - must be accutate) OWNER NAME: *-Yur - \T-',l.' ' CONTACT PHONE #.Ml r- - "Lla1 PROPERTYADDRESS: {-\le:r Furr.trr*rr' - b\\ 6 \er Ll PHONE #: Home Work Cell O\X/NER MAILING ADDRESS:Z\? usr\. O?.glTY' P€\#-ezSTATE: Lb> ZIP: 69'4eD EfrmfI, APPLICANT (If other than owner) (Applicant if other than owner, a statement authodzing applicant to act as agent APPLICANT INFORMATION: ADDRE,SS for owner must accompany this application.) CITY: STATE;-ZIP- EMAII. FAX PHONE #: Home Work Cell CONTRACTOR: MAILING ADDRE,SS: PHONE: Cell# CITY STATE ZIP Work#Fax# E,MAIL IDAHO REGISTRATION # & EXP. DATE Business Applicolion C I'I'Y O F 35 Norih I't Eosl Rexburg, lD 83440 Phone: 208.359.3020 Fax: 208.359.3022 REXBURG'ftr'' A nt ri lr's Family (i) n m u nily Please take the time to answer all questions so thal we can further assisl you and your facility Thank You. What type of business will be performed Eeua-ar\zt*[ Will the business have food preparations? Will there be any cooking of foods? Will there be any deep fat frying? Will you have food disposal on site? Will there be any maintenance or mechanical work in the building? Will there be sumps or floor drains in the facility? Will the business require more parking? Will the business have any chemicals on site ? Is this business occupying an existing building? Will the business be doing any structural/or remodeling changes to the building? Any changes to the electrical? Any changes to the plumbing? Is this business planned to be the same with different ownership? Will there be a change of occupancy? gYes /No gYes dNo $Yes flNo $Yes 9No $Yes 6No QYes dNo Q Yesd No QYes dNo fives O No fives O No QYes f,wo $Yes dNo QYes 0 No Q Yes /*o I Certify lhat The information thal I have provided above is to the best of my knowledge accurate and true. Applicants Signature Phone Date Building Sofely Depqrlmenl City of Rexburg Phone:208.372.2326 Fax: 208.359.3022 rY REXBURGc\r, Ante d cai l:amily Co rn nn uil tywww.rexburg.org Properly Lines Each site plan that is submitted to the City of Rexburg for the Building Permit process requires that property lines are shown accurate\. It is the Developer's responsibility to correcdy identi$r on the site plan the location of these lines in refetence to the public right-of-way, other adjoining property lines, the street, other structures and all utility lines. The Developer should find propetty pins that are still avallable at the lot in question. If these pins do not exist or have become unrecognizable then a new survey should be performed. Accurate property line infotmation is a must for a timely review. In addition to finding existing properry pins,legal descdptions should be checked. The best way to identift ptoperty line location is vdth aland survey. The City of Rexburg has aerial photos and a parceI line layer that can be checked, but they are only a tool and are not guaranteed for acctxacy. If you want to tequest a copy of your lot, see the front counter at the Community Development Department. I have read and understand the above requirements. Signature Date Printed Name State of Idaho County of Madison AFFIDAVIT OF LEGAL INTEREST ) ) ss. ) The undersigned, being first duly sworn, deposes and says: A. that he is the authorizedrepresentative of Brigham Young University - Idaho (the "University") for the purpose of submitting the attached application (the "Application") including the making of this Affidavit; B. that the University is the record owner of the property described in the Application; and, C. that the University agrees to indemnify, defend and hold Rexburg City and its employees harmless from any claim or liability resulting from any dispute as to the statements contained in this Affidavit or as to the ownership of the Property which is the subject of the Application. ou"a'3ffi,2o1+ Subscribed and sworn to before me the day and Notarv Public Residing at: My commission expires: -.r\\\lll t t I l,l///r, - s----\.q.t:::;t;:.:.;2 = 5 *f- : =ta;#N 9.- L:i i'i ili i;ij"'rif;-fi f*iii iiY; liiii'11g iE; iis,rii;l.ii4 iil jilliij'i"'i:i'i i'ii ii,it , r,;,:r,;: i;[i;i'i'i'i iillr ']4'ii4i! iili: iii!: ijl';::i i:if E'Liii, iiif i'L*iii:iiiLi': {:i.iii 'o'"i:liiiLli i'i;;:iiiI iiii'l* -iilil'iirj ir ru:1. i'iiiiii ii iiiiiii ri.{::" i'] g unity ffiffiffiffi*ffiK Date: 0810412014 ReceiPt #: 2594 l'r"ifiii *i{il'Lii'l7 I'iTiiiljT i'r-iAiiGt l lt_;i,i I T + i 4,.-ri._{.:+ i!-i*i'ii'i iIii *iii.i i{'i'ii ii liiii l!*T l"q{ " 1;',1 Iiii, ..iii ri .,Ji-l Hart 141 Dance Floor Remodel ..:.. Hart Building - 31 1 S. 1st W. Peryf t Type_i F LQ_:c,-o,M R" t,,.,/e,,rg / 9lr,l/\' Please contact the Building Department at (208)372-2341 for further questions about this receipt ew Fee crrY fiF RExBqag 24Hour Notice for insPections Gall inspection hotline at 12081372-2344 ***Credit card payments are accepted, but are subject to a 3% convenience fee on payment amounts over $500""' e:4e fiii ili Fiiiii Fi: liiii ii*Ti; ii?/iiiii4 iiHf: id;LI:;it -11 li.j!LiiIi.iri i'i!i:H.ii l:i-:i:i:riFiI iii: ii!T:ii"iiiili iif i.r j.i i ijrl; -l4iili-; iiii: ii:i: 'ii,.iiitj iiiFil: :ii:ii ,, iiil G unity Date: 0712812014 ReceiPt #: 2526 Iriiiil iti'iIU]iT F*liiii'ii !-i-ifinLlL i:i:,!:iii I i ii 1 4ll'rl,i ::4 HiF:i iiAi4li ii.i.riii;j TH*i'ili i,ilu rliiii Hfr''Ji: * iii[i l!ri] I ild , Lil lrill , ilij i " ill-i Project: Address: Hart 141 Dance Floor Remodel Hart Building - 311 S. 1st W. #: 14-00324 Type: BLD-coMR Permit Permit Please contact the Building Department at (20A)372-2341 for further questions about this receipt $100.00 F-Kl-ili JUL 28 2014 |i CIW OF RFXBURG 2822010 24Hour Notice for insPections Gall inspection hotline at (2081372-2344 ***Credit card payments are accepted, but are subject to a3o/o convenience fee on payment amounts over $500*** 1