HomeMy WebLinkAboutAPPLICATION - 17-00022 - 1145 S 2nd E - Cell TowerCITY OF
REXBURG
Anredcn's Family Community
BUILDING PERMIT FORM 200
urydal 1012016
BUILDING APPLICATION
Commercial Addition
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
PermitNumber: L7_•Do4Y Zoning:
Application Fee: ❑ $1000/Building
1. Property Owner
Name: Seriiica c
Address:ares5 ts.n
—� City:5oun12,altorl State: EL Zip Code: 33kS>'7
Phone: Z t - k,,3& - g71
Email: i le, rev
2. Applicant
Name: Alex to Role: (Owner, Tenant, Contractor, etc.)Tower Owner �5 a
Address: 7zcfl 5. 2euere_ PAgWg1 54 9b3 City: CenJenlifel State: ff Zip Code: RDII
Phone: 7 ZO - 63r - N71 Email: 0.w0 i_� 110,)i SbaS; COWL
Contact/Rep. Name: Aig x ( r; 5AA t4elmo(t
3. General Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Name: [9rc Se.r Arrow c-+mry mica hbrla Registration#: 59542G's -55bI Exp.:
Address: `/75 taicck 3c,00 S. s -if<.. p City..)} Lq cj}..t State: 1)T Zip Code: 8 4115
Phone: STU1 - 936 ^ lo2u Email:_ad.6;are. bA wvvi^Ine- coon
Contact/Rep. Name: A„1'han8 D4;ore Phone: gut - 136 - ioaoEmail: 5a at IoDyQ-
General Contractor Authorized Signature: — Date: i 13 1 /%
A copy ofyour state registration license is required to be on frl . this is the first tlmeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyofir license is on file, please check with the Permit Technician by calling (208) 392-2341.
4. Project Description
Address:_jlg5 5. Ind E TeX oral Ill 8341go
Project Description:
• Square footage of addition:
• Total cost of project- materials and labor: $ 101000
• Check all that apply:
19 Mechanical: Cast $ NI o00 ❑ Electrical: Cost $ ❑ Plumbing: Cost $
❑ Fire Alarm: Cost$ ❑ Fire Sprinkler: Cost$
Note: Any contractors involved will need to fill out their respective application.
• Change of Occupancy? ❑ No ❑ Yes: New occupancy:
• Other Comments (if any):�S e n la e
1-- �.-� A n Je Wa t t�Cr I cabLa
Building Permitfeesfor 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 he a
plan review fee totaling 10% ofthe building permit fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the Information herein
Is correctand I swear thatany information which may hereafter be given by mein hearings before the Planningand 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 latus relating he the subject matter of this application and herebyauthorized representatives ofthe
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 ofany false statementonNsrepresentation offact in the application or on the plans on which the permit or approval wasbased. Permitvoldifnot
startedwlthm 180 days. Permit void Ifworkstops for 180 days.
Applicant's Name (print): Ate to ik Signature: a v �_ Date:I L Z l7
inspections must be piled in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled far the next business day.
Inspection hotline- (208) 372.2344 wwwrexhurg.org Perm t Technician- (208) 372.23 41