HomeMy WebLinkAboutAPPLICATION - 17-00254 - 433 Airport Rd - Self Storage Plus - New RV BuildingCITY OF
REXBURG
Americas Family Community
BUILDING PERMIT FORM 2�0
upaato 101201 6
BUILDING APPLICATION
Commercial Addition
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Zoning: Application Fee: ❑ $1000/Building
1. Property Owne�� 1t}!"A
PName: EW tioa 14>/R(ewaeu'�
Address: J 3/03!�City t__A
Phone: � 6tSr
7 - //91" mair.. W40g,SrPV 5r���e• ezy_ e
2. Applic t
Name: 0.r s Role: (Owner, Tenant, Contractor, tc.) o W—
Address: �8 U eS f FP f S � City: k✓ StateJ� Zip Code: D
Phone: DH.g�� y4 ^a/21m)09. Ce/si-
Contact/Rep. Name:
3. General Contractor
Under Idaho Building Code,q rggistered contractor must do the work for a Commercial Building.
Name:— ��C'�i/YlY' Registration#: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date:
A copy ofyour state registration/license is required to be on file. If this is the first timeyou 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.
4. Project Description
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Address: A7 3 � 1 r P6 r+
Project Description:
• Square footage of addition:
• Total cost of project - materials and labor: $ / C)o6 be) a; 0 e)
• Check all that apply:/ //
13 Mechanical: Cost $ //J 5C41ectrical: Cost $A5111 ❑ Plumbing: Cost $
❑ Fire Alarm: Cost $13Fire Sprinkler: Cost $�
Note: Any contractors involved will need to fill out their respective application.
• Change of Occupancy?AnvNo ❑ Yes: New occupancy:
• Other Comments (if any):
Building Permitfees for commercial construction are charged based on square footage and the City's estimated valuation. The
application fee applies toward the fee total. For details on how fees are calculated, contact the Building Department There will also be a
plan reviewfee totaling 10% of the building permitfee.
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APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l 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! n 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.
Applicant's Name (print): Signature IJAJ,VV �r Vel
Dater r
Inspections must be called inbefore 8 AM on the dayt inspection is requested. Inspection requests called in aRerB escheduled for the next business day.
Inspection Hotline- (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341