HomeMy WebLinkAboutAPPLICATION - 16-00674 - 525 S Center St - BYUI - Clark Classroom RemodelCITY OF
RMURG
America? Family Community
BUILDING APPLICATION
Commercial/Multi-family Residence
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use Digital Plans Included: ❑ CD 13 USB ❑ Dropbox ❑ Not Included
PermitNumber: -0 Permit.Type: ❑ New M Remodel ❑ Addition
Deposit Amount: O $1000 New Const O $250 Addition NQ$100 Other Deposit Included with Application: ❑ Yes ❑ No
1. Property Owner
Name:
Address: C OI{i I 131 I City: � C� State: Zip Code: 440
Phone & Type:6,60) 40(6- I�-J l `iy(Office 0 Mobile Email:
Under Idaho Building Code, a contractor must do the work for a Commercial Building.
2. Applicant ,>
Name: ia (6� C�` ) Role: (Owner, Tenant, Contractor, etc.)
Address: G49 City: `�> �- State: L Zip Code: c 41
Phone &Type: 0-0' ) gOfficeEl Mobile Email• F-F--AY-c4a.tOa(�60-t=�-Sk-LS. 'ZDt1
Contact/Rep.Name: C-Phone:(20:11�35-Z'1&,Email:_�i01�C5fz�f�
3. General Contractor
Name: Registration #: _ Exp.:
Address: City: State: Zip Code: _
Phone & Type: Cl Office ❑ Mobile Email:
Contact/Rep. Name: Phone: Email:
IGeneral Contractor Authorized Signatures _ Date:
4. Project Description
Address: JOWL L- z 131h4r13 fit T -OR- Lot #: _ Block #: _ Subdivision:
Type of work:
Check all that apply: 'l Framing ly, Mechanical V Plumbing )d Electrical
NOTE: Any sub -contractors involved will need to submittheirown signed applications.
Description of work: OF CLA—, 9 KNF-j � 7hh J.f �l�LSS
*Total cost of project -materials and labor: $ (used to calculate permit fees) # Of Buildings:
Building 1: __Units (0� a77: sq. ft Building 2: _Units sq. ft. Building 3: _Units sq. ft.
Additional Buildings:
Utility, Mist, Private Garage: sq. ft. Storage: sq. ft
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofper)ury, I hereby certify that l have read this application andstate 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 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 ofthe 2012
International Cade in cases ofany false statement or misrepresentation offactin the application or on the plans on which the permit or approval was based. Permit void ifnot
started within 180 days. Permit void ifwork stops for 180 days.
Applicant's Name (print): L�A"Po Signature: Date: W- ¢ [C,
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 next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016