HomeMy WebLinkAboutAPPLICATION - 16-00654 - 127 W 4th N, Rigby - Shop AdditionCITY OF
REXBURG
Americas Family Community
BUILDING APPLICATION
Commercial/Multi-family Residence
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use J Digital Plans Included: ❑ CD ❑ USB ❑ Dropbox ❑ Not Included
Permit Number: lU ����� Permit Type:. ❑ New ❑ Remodel ❑.Addition
DepositAmount: El $1000 New Const ❑ $250 Addition ❑ $100 Other Deposit Included with Application: ❑ Yes ❑ No
1. Property Owner
Name: 14 e ( „Afftt' '7
Address:JRJ J- - L02' �) • — I City: h� State: it Zip CodeF5YY,>
Phone&Type:�L'I7.3D _❑ Office IFLMobile Email: 14 v -Fl -e i'�lUm Sfl,�. ,riov�,<-ii•icy
Under Idaho Building Code, a contractor must do the work for a Commercial Building.
2. Applicant
Name: Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone & Type: _ ❑ Office ❑ Mobile Email:
Contact/Rep. Name: Phone: Email:
3. General C tractor
Name: f Registration #: __ Exp.:
Address: City: State: Zip Code:
Phone & Type: ❑ Office ❑ Mobile Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature{ Date:
4. Project Description
Address: -OR- Lot #: Block #: Subdivision:
Type of work:
Check one: ❑ New Construction ❑ Remodel* ❑ Addition*
Check all that apply: ❑ Framing ❑ Mechanical ❑ Plumbing ❑ Electrical
NOTE: Any sub-contractorsinvolved III needtosubmitthe' wn signed applications.
Description of work:l y '8S I ) ' � `1AAi-.�1_��
*Total cost of, - materals5 and labor: $49,, (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, Misc, Private Garage: sq. ft. Storage: sq, ft.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty ofperjury, I 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 I agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hereby authorized representatives ofthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permiton approval issued under the provisions ofthe 2012
International Code in cases of any false statement or misrepresentation offact in the application or on the plans on which the permit oyeppmval was based. Permit voidifnot
statedwithin 180 days. Permit void if work stops for 180 days. / )
Applicants Name (print):
Date? '?4 �(te
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the nextbminess day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016