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Gertificate of Occupancy
City of Rexburg
Department of Community Development
35 N. 1st E. / Rexburg, lD. 83440
359€020 / Fax (208) 359-3022
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
12 00532
lnternational Building Code 2009
173 E Main, Ste B, RigbY, ldaho 834{'2
Royal Journey's, LLC
Type V, non-rated
210
No
Contractor:
Special Gonditions:Based on existing building inspection for life safety issues only.
Occupancy:Residential - 2 units or less, permanent in nature
This Certificate, issued pursuant to the requirements of Section 1Og of the lnternational Building
Code, certifies that, at the time of issuance, this building or that portion of the building that was
inspected on the date listed was found to be in compliance with the requirements of the code for
the group and division of occupancy and the use for which the proposed occupancy was
classified.
Date G.O. lssue
C.O lssued by:
Building
There shall be no further change in the existing occupancy classification of the building nor shall any structural changes,
modifications or additions be made to the building or any portion thereof until the Building Official has reviewed and
approved said future changes.
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Rexburg Building Depa rtment-
RoyalJourneys is a Developmental Disabilities Agency providing
developmental therapy. We are not educational and our clients are not
in our custodial care as an l-4 building classification, but shoutd rather
be categorized sinrilar to an occupational Therapy or Speech Therapy
agency. Our buildings are used exclusively to provide these Medicaid
reim bursed medica I therapies.
At no time will non-ambulatory personal exceed the number of fire
safety trained staff, therefore we believe we qualify as R-3.
Feel free to call me anytime regarding the nature and scope of our
services.
Program Manager
709-0s37
a01
rossman
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RESIDENTIAL BUILDING PERMIT
35 N 1" E,, RE,XBURG, ID 83440
208-372-2326
PARCEL NUMBER:
SUBDIVISION:
(Addressing is based on the information - must be accurate)
Dwelling Units:Parcel Acres:_
Pl9ase Completile E ntire r\pplication!
If the question docs nor apply fill in N;\ fcrr non applicable
APPLICATION
( We will provide this for you)
UNIT# BLOCK#- LOT#
CONTACT PHONE # 7O1-O'92
PROPERTY ADDRE,SS:
PHONE Home (
O!7NER MAILING ADDRE,SS:
E,MA t \e"t rt
T3 work( )_cex( ) 'q*o577
STATE,:-ZIP:
LO.n4 ^x 7?5 t3%<f
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing atpplicant to act as agent for owner must accompany this application)
APPLICANT INFORMATION: ADDRESS
STATE;-ZIP EMAIL FAX
PHONE #: Home ( )
CONTRACTOR
MAILING ADDRESS: -CITY STATE-ZIP
PHONE #: Home ( )
E,MAIL
Work (
FAX-- IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this propertyi
Did you tecendy purchase this property? No yes (If yes, list previous owner,s name)
Is this a lot split? No \1iS @lease bring copy of new legal description of property)
PIi.OPOS}ID USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Gange,Cornmercial, Addition, Etc.)
:':ill::)Ij.:]!YTY*, CERTIFICATION AND AUTHORIZATIoN: ,Under penalty of periury, I hereby certify that r have read this
[]::l'::.::ii:::*.:-":.Tl:::: T,l::.1?_!::f1l- the ciry orRexburj shal be ;'if,i;;;',;;; l;;; i;';;ril; "rltff,#ff.^. -.
for inspections Purposes. NoTE: The building officril may r.rrok. u permit on "dt;;Jil;;;;;;,k;;;#;t"ft;;#;i;;#ffi#::;cascs of any false or mlsrepresentatron of fact in the application or on the plans on which the permit or approval was based. permit void if notstarted within 1 Permit void if work stops for 180 days.
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re or erlApplicant ll t tdt, / l>
DATEWARNING - BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!Plan fees are non-refundable and are paid in full at the time of application Aeginning k;;q, t, zOOSCity of Rexburgts Acceptance of the plan review fee does not constituA ptal aiprorrl't**Building Permit Fees are due at time of application*x **Building Permits are void if your check does not clearx*