HomeMy WebLinkAboutAPPLICATION - 17-00362 - DL Evans Bank - Tenant FinishCITY O F
REXBURG
C\j
America's Family Community
BUILDING PERMIT FORM 202
Updated ]0/20]6
BUILDING APPLICATION
Commercial Tenant Improvement
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: Application Fee: ❑ $100
1. Propert Owner
Name: G ,%s
Address: P q' City: h 1- r r 4 State: -T-0 Zip Code: 933/tr
Phone: 009-- Sia 3 - � �--41 Elnal : � �r.tif r � r✓ � �h KS .Ccs �^""�
2. Applicant J { //��
Name: AX541-di'011 �fk�Pt 14' (t rnPa K,I Role: (Owner, Tenant, Contractor, etc.) �l
Address: _ City: _,y v n wta *'t State: �T+ Zip Code: 5s3"e/a j
Phone: ?o - � 'Y� Email: ►� `( C$ e i
Contact/Rep. Name:
3. General Contractor
Under Idaho quild' g Code, or �igistered contractor must do the work for a Commercial Building,
Name: n ►'"+� ` w w I' �, n Registration #: RC Exp.: /g,
Address: Z /1/0 X. r City: '4►K W%0 H State: TZip Code:
Phone: .2�- !0.1 Email: 4 erj • G �
Contact/Rep. Name: Jaeej ~, em, e- rfP I 0f Email: 't `+
7rGeneral Contractor Authorized Signature: Date: - 7 3t/7
A copy ofyour state registration/license is , equire 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
Address: ) Vk Ile y, �I'Veer bri've Sid' Sar
Description of Work: _12—;7_00 SP 77-r- 1�gr U Etc• -As &
_c.� ra Itrh
Project Description:
• Total cost of project - materials and labor: $ 23�7
• Check all that apply:
0 Mechanical: Cost $ IR Electrical: Cost $�� M Plumbing: Cost $ /d ) (UC,
❑ Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $ _
Note: Any contractors involved will need to fill out their respective application.
• Change of Occupancy?/VNo ❑ Yes: New occupancy:
Building Permit fees 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 review fee totaling 10% of the building permit fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that 1 have read this application and state thatthe 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 in cases of any false statement or misrepresentation of Fact in the application or on the plans on which the p mlt or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
I V_
Applicant's Name (print): sJOt Signature: Date: 7 /
Inspections must be called in before 8 AM on the day the inspection is requested. luspectl Vrequests rAllcd in after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341