HomeMy WebLinkAboutAPPLICATIONS - 17-00626 - 1175 W Main St - Valley Wide - Addition & RemodelCITY OF
REXBURG
America's Family Community
BUILDING PERMIT FORM Z O3
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BUILDING APPLICATION
Commercial Addition
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: a-ou 6" Application Fee: ❑ $100
1. Propertypwner
Name: tylorL(_pt��t=TZAVLr rte_
Address: P ZJKXC)t City: J F-rZCM � State: �___ Zip Code: 27
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Phone: �bm A 0 Email:
2. Applican
Name: vlo 1�IPr1/14W1v Role: Owner, Tenant, Contractor, etc.) C0ruYL
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Address: Y61 oY City: State: Zip Code:
Phone: -2oi q,� Email' RUlO IEYY113 YlYV �LU1L76 (0Yil
Contact/Rep. Name:
3. General Contractor
Under Idaho Building Code, a registered contractor must do th work for a Commercial Building.
Name: igMiai'VIU DEsj(,N/all/f) 6tyZTl e 1 trationIt: RCE-30'11Exp.: O .2 �
/LFc/ State:
Address: 6 %��o � U City: �} _Zip Code:
Phone: Email: Dj0oP- 'ft 197M argry S)it T'. Cid rvt
Contact/Rep. Name: '124010 KF(n)4WA/ Phone:;Orf,?31MEmail: 1,W1100 KiF-MRYvrV IcT.0
General Contractor Authorized Signature: [2 Date: b
A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City ofRexb rg, please provide
a photocopy afyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address: 11W01Jt MJ V5? 2 ET
Description of Work: N/=(�tJ{�1'J10YU %3; o2f oZ 15- 159 = %
Project Description:
• Total cost of project - materials and labor: $ Z, 00 yl 31 Z, OO
• Check all that apply:
❑ Mechanical: Cost $ ❑ Electrical: Cost $ Cl Plumbing: Cost $
❑ Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $
Note: Any contractors involved will need to fill out their respective application.
• Change of Occupancy? L5 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 reviewfee totaling 10% of the building permitfee.
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I 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. 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 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. Permitvoidifnot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print) uu fL1F Signature: Date: to/a6
Inspections must be called In before 8 AM on the day the inspection is requested. Inspection requests called in af[ereAM will he scheduled for the next basin ss day.
Inspection Hotline - (208) 372.2344 www.rexhurg.org Permit Technician - (208) 372.2341
CITY Of
REXBURG
ro,
Americas Family Community
DISTRIBUTION LIST
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
Please provide the names and emails of anyone who should be getting automated updates for this project.
Review Notes
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Name: 7aui0 �iGblY3yr,,J Email: DAL)lfl Cl�—rE-AAl1)1V MRSM4
Name: 3riY (-6Yll5-- Email: Jca'tiF �J IrYYCOtU>rf�TL�jll I r, Cowl
Name: FLo�a Wag
Name:
Name:
InspectionTickets
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Email: U'(Z. MQUALL-EYLUIDELoap, Con
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Email: T AWALGIZA Iq- COY\
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Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised 10/2015
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CITY OF
REXBURG
C
Ameriw' Family Community
SUBCONTRACTOR LIST
Excavation & Earthwork: ZOLLI Aj &Er7�C7IV C71oYl),. /iUC,
Concrete: YL) WF—S%— CONST2lr'nyv
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists: _
Siding/Exterior Trim:
Other:
Building Safety Department
City of Rexburg
35 North 15t East
Rexburg, Idaho 83440
Inspection Hotline -(208)372.2344 w .rexlmrg.org Permit Tech nician - (208) 372.2 341 Revised 10/2016