HomeMy WebLinkAboutAPPLICATION - 17-00118 - 555 W Mikan Dr - Eden Apartments Site PlanCITY OF
REXBURG BUILDING PERMIT FORM 3�0
Q�+ Updated rn/2ots
Americas Family Community
BUILDING APPLICATION
New Multi family Residence
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: l7' ° 011 V 131 Zoning µ0 2 y Application Fee: ❑ $1000/Building
1. Proper �}}Owner
Name: Kegp_ UC' .ff,3L yr%
Address' SSg S. u w iutiC71J1 City: U State: D Zip Code:
Phone: 20�-'�-64-1o526 Email: Kav,WL, rlhc-COwI
2. Applicant'O j //11 f ) _
Name: fiG-"lv\f ^ (J(91MM1ty)LOq1� Rays, Rol (0 ner, Tenant, Contractor, etc.) Am"C'�1 r
Address: �iS S-uelows ke MV- SurIL201 City: of Stae; Zip Code: A3yyD
Phone: 20 '7 9-GIV Email: Co `t� ��rrk kcrihc-Cty�
Contact/Rep. Name: e
3. General Contractor
Under Idaho Building Code, a registered contractor must do the work for a Multi family Residence.
Name: CW"rGt'lkV r_ N Cr'll Uil" Regi tration #: C�-�y Exp.:
Address: S 4 S• Yes e ?o City: � State: (I Zip Code: ATS/%
Phone: ZO'V T5'0 (oZi Emai .
Contact/Rep. Name: OCAIU$+C Ph Email' _ _U A"'y upte,^ /ttC-66 W-1
General Contractor Authorized Signature: + Date:
A copy ofyour state registration/license is required to be o I le. Ifs! Ise the first timeyou have done work in the City of Rexburg, please provide
a photocopy ofyour license. If you are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description ``,,��qq ]]
Address: 10 4D S- �6 W e5� V'eXI ? -OR- Lot #: _ Block #: —Subdivision:
Project Description: U
• # of Buildings: J3 # of Units:
• # of Water Meters: —LIL Water Meter Size(s): Z
• # of Parking Stalls: R7(0
• Estimated Cost: $
• Proposed Use: ❑ Dormitory Housing i&on-Dormitory Housing
• Construction Type (i.e. VA, VB, etc.):
Building Permitfees for multi family residences are charged based on square footage and the City's estimated valuation. The application
fee applies towards the total fee. For details on howfees are calculated, contact the Building Department. There will also be a plan review
fee totaling 10% of the building permitfee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the information herein
is correct and 1 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 offact in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days. ^yt�
Applicant's Name (print): l� �e� Signature: Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspectio4requesn after AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexhurg.org Permit Technician - (208) 372.2341