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HomeMy WebLinkAboutAPPLICATION - 17-00441 - Mountain Lofts - RemodelCITY OF REXBURG cy� Ameriwg Family Community BUILDING PERMIT FORM 201 npda,M 10/2016 BUILDING APPLICATION Commercial Remodel Building Safety Department City of Rexburg 35 North 11t East Rexburg, Idaho 83440 For Office Use Permit Number: Application Fee: ❑ $100 1. Propertywne Name: our Address: 53 - Q N -6J City: 1 �k' State: 51� Zip Code: t0 Phone: �a_A - 39D - q,SM Email: 41ar . dw@ /qS , Lew 2. Applicant 11 (� / Name: a(T, I �u1Pto Role: (Owner,Tenant, Contractor,e ) tuCTo✓ Address: Xn �i. )e.vn City: tater Zip Code: 83x140 Phone: - - Email: T451y. Gem Contact/Rep. Name: //%af u 3. General Contractor Under ldah�Q�Bu ldin$$��Cod�e+, �a registered contractor must do the work for a Commercial Building. Name: Aa(_ I aA in7 Regis ration#:VC%T-1'0035—Exp.: .Ta&, 1?l jR fl Address: T City: c u Staff Zip Code: S33'{t b Phone: Cn 7nf h Ff1'r Contact/Rep. Name: one: Email: General Contractor Authorized Signature: Date: 7-31-0 A copy ofyour state registration/license is required to be on61 . If this (Wefirst time you have done work in the City of Rexburg, please provide a photocopy 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: Sag s • ;)N ,j Description of Work: Project Description: • Total cost of project - materials and labor: $ lo-? 1 661) . 496 • Check all that apply: � -� 13 Mechanical: Cost $ 13 Electrical: Cost $ ~%S© 1_� 1:1 Plumbing: Cost $J1_4_900 len ❑ Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $ Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? Pi No ❑ 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 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 me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. 1 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 Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void Huai started within 180 days. Permit void if work stops for 100 days. Applicant's Name (print): Signature: Date: Inspections must be called in before B 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