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Home My WebLink AboutAPPLICATION - 17-00279 - Broulims Remodel - PharmacyCITY OF REXBURG nv America's rionify Community Submit By Email BUILDING APPLICATION Commercial/Multi-family Residence Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Digital Plans Included: ❑ CD ❑ USB ❑ Dropbox ❑ Not Included Permit Number: Permit Type: ❑New ❑Remodel ❑Addition Deposit Amount: ❑ $1000 New Const O $250 Addition ❑ $100 Other Deposit Included with Application: ❑ Yes ❑ No 1. Property caner Name: iMS ywA Address: ($2- I dolyt 3TPrTe, City:�i�y State:�Ct�11 _; L_ Zip Code: R34 2- Phone&Type: ❑Office❑Mobile Email: Under Idaho Building Code, a contractor must do the work for a Commercial Building. 2. Applican Name:(a I.A _ fi.ls Role: (Owner, Tenant Contractor, etc.) C _ Address: (Abs R- (Z� City: MAIN R_&Ae`j State: tD Zip Code: 2 Phone&Type.1=EW 2Q31-pgOffice ❑Mobile Email:lu{. 'C6m Contact/Rep. Name: Phone: m il: 3. Genera Contractor _iz i4 /n Name: hl� — i flat L Registration #:2C -V-- l (C5 Exp.: Address: jp City E ail: 1'� State: Zip Code: �i . C i Phone &Type: QJfS Office E3 Mobile Email: t t I \ 1'1y�t S, � m n -%Y ]l /wA Contact/Rep. Name Phone: (Email: - / General Contractor Authorized Signatur P. Date:52h/[Z 4. Project Description Address: 12 -OR- Lot #: _ Block #: _ Subdivision: Type of work: Check one: [3 New Construction Remodel* ❑Addition* Check all that apply: IP, Framing ( Mechanical ❑ Plumbing 0,Electrical NOTE: Any sub -contractors involved will need to submit their own signed applications. Description of work: DIUIof AQCC tADl DXL5 AWLY57 fl-LBLT I- MZCk, *Total cost of project -materials and labor: $ (used to calculate permit fees) # Of Buildings: Building 1: _Units sq, ft Building 2: _Units sq. ft Building 3: _Units sq. ft. Additional Buildings: Utility, Mist, Private Garage: sq. ft Storage: sq. ft APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I 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 mein hearings before the Planning and Zoning Commission or the City Council for the Cityof Rexburg shall be truthful and correm I agree to comply with all City regulations and State laws relating to the subject matter ofthis 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 ofthe 2012 International Code in cases of any false statement or misrepresentation of fact in the appli nation or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void ifwork stops for 180 days. Applicant's Name (print):L-� A&M vSl11LW>Signatur� `Date: S Z3 Inspections must be called in before SAM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the nextbusiness day. Inspection Hotline -(206)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG nv America's Family Community Excavation & Earthwork: Concrete Building Safety Department Submit By Email City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Subcontractor List Masonry: Roofing: Insulation: ' — Drywall: MP.MJAI k— H AI A Painting:A717-, 7--lA Q — H A(,- - / Floor Coverings: W/I� z UTA,.C. (I� Plumbing: Hearing: 2) t-5 Electrical: AW R WLAC-LC- �r1Z� Special Construction (Manufacturer or Supplier) Roof Trusses: — Floor/Ceiling Joists: Siding/Exterior Trim: Other: Inspection Hotline -(208)372.2344 wuay.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 pf PExaUkC C 1 'I' Y O `7y BuildingSafetyDepartment P T EXB mG Submit By Email City of Rexburg Ow 35 North 1st East Americas Family community Rexburg, Idaho 83440 BUSINESS USE SUMMARY The following questions will help speed the review process along. Please take the time to answer all of them. 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? Any changes to the mechanical system? Is the business type changing? [I Yes, it will change to Is this business changing ownership? ❑Yes ONo KYes []No %Yes ❑No []Yes ANo P(Yes []No we []Yes V[No Is the business registered with the City of Rexburg?O,Yes, License #: ❑No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? ❑Yes ONo Will there be any cooking of foods? []Yes kNo Will there be any deep fat frying? []Yes E,No Will you have food disposal on site? []Yes KNo Will there be sumps or floor drains in the facility? []Yes OANo Will the business have any chemicals on site? ❑Yes FjNo C2Q�3) 5z3 Applicants Signatu a Phone Date I certify that the information that I have provided above is to the hest of my knowledge accurate and true. Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 1" O F EX RI3URG t'vmieinup. XBP Confirmation Number: 30169030 City o/ Rexburg 35 N 1st East I PO Box 280 Rexburg, ID 83440 208-359-3020 ub@rexburg.org / Transaction detail for payment to City of Rexburg. Date: 0512412017 - 10:04:12 AM Transaction Number: 68913252PT Mastercard — XXXX-XXXX-XXXX-8698 Status: Successful Account# Item Building Permit Quantity Item Amount $100.00 TOTAL: $100.00 Billing Information Transaction taken by: amandaw ,83440