HomeMy WebLinkAboutAPPLICATION - 16-00795 - 24 W 1st S - Mechanical Onlyak Rfi%a(:Fc
CITY OF
REXBURG
r
Amcrim4 Family Community
Building Safety Department
submit ay Eman City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial/Multi-family Residence
Far Office Use ' a� �, �r , Digital Plans Ihclud@d C� CD ❑.USB ❑ Dropbox ❑ Notlncluded,i
Permt Number' < �. Penn tTyp"e: ❑ New ❑ Remodel 11 Addition
DeposltAtil$UiYU17$1bolNezvCbhsLC�250*Addlhoq❑ $1000ther DepositIncluded�withApplication: ❑Yes` ❑No'
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1. Property Owner ��11
Name: j ak'% VemOPlHa
Address:oZy� S. City: (-¢*,4!2y -a State: .30 Zip Code: Fc344D
Phone&Type: ❑Office❑Mobile Email:_
Under Idaho Building Code, a contractor must do the work for a Commercial Building.
2. Applic�an"t
Name:\e� �rQ v f. /+relrir Role: (Owner, Tenant, Contractor, etc.)
Address: �j 55i a q F A-45 A) City:rZ�a kw Stater— Zip Code: RAYZQ
bZ
Phone & Type: � J- T -702kI t,�fOffice [3 Mobile EmailT
Contact/Rep. Name: .)&Anti. Clae'nr� Phone:`)DS-7A/,TZOa4 Email; O iz��aJ/hui)�.v DhPP�u
3. General Contractor Iii a—&a/ YS/�
Name:y iY1Co C'L ra 0A Registration #: [dI �C5 � Exp.:
Address: -73 E rfgO Q City: State: Zip Code: AN44,2
Phone&Type: )D&7Iq%=oat VQ Office ❑Mobile Email: Q- t o 4E?Mode*^olno.Cai1_
Contact/Rep. Name: Phone: Email:
Gener4Cgltcact`frAu}3FnrizeSignattue 4inLe Date: It 30
4. Project Des�c1ription
Address: 19 � i St S . -OR- Lot #: _ Block #: _ Subdivision;
Type of work:
Check one: ❑ New Construction RRemodel* ❑Addition*
Check all that apply: ❑ Framing EA, Mechanical I$ Plumbing ❑ Electrical
NOTE: Anysub-contractors involved will ryryeed to submit Neir own signed applicadons. , �j,�
XEm
Description of work: ne �Va�Tv� Yi�d{vIo a t� —t�Siat'd lv-ite su. bL&'N —
*Total cost of project - materials add labor: $ i'1.5a.G (used to calculate pe it fees) It Of Buildings:
Building 1: _Units sq. ft. Building 2: _Units —sq.tt Building 3: _Units sq. ft.
Additional Buildings:
Utility, Misc, Private Garage: sq. it Storage: sq. ft.
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 mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct. 1 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 permitan approval issued under the provisions ofthe 2012
international Code in cases ofanyfake statement or misrepresentation of fact in the application or on the plans on which the permit orapproval was based. Permitvoid if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): \) ,Ate 1 . Cd ✓Vl Signature: �) iZgCQR11%, 14 Date: 11
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called 1n after 8 AM will be scheduled for the next business day.
Inspection Hodine — (208) 372.2344 www.mxburRorg Permit Technician—(208)372.2341 Revised March, 2016