HomeMy WebLinkAboutAPPLICATIONS - 18-00405 - 39 S 2nd W - Great Scotts Remodelof a�BU.q�
CI TY ° F Building Safety Department
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REXB V RG BUILDING PERMIT FORM 2 01 City of Rexburg
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Ame35 North 1St East
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America's Family
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Remodel
For Office Use
Permit Number: �,t - o6 4C S
Application Feer $100 V4 -/N Proper Owner .1N Name: p*Lsprj
Address: 3q 5. Z•NQ UJ
City:- G�`8 l: State: L D Zip Code: $ 3y y n
Phone: -92,r- qz? - ci ZO 1
Email:
2. Applicant n
Name: �a�c�= (,&!&ate_ Role: (Owner, Tenant, Contractor, etc.).►
Address: �i �R iC', Z ,.► D
City: ail: -ry
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Phone: --tate: p Code: 8 3 y�
Contact/Rep. Name: Email:
3. General Contractor
Under Id ho Building ode, a registered contractor must do the work for a Commercial Building,
Name: G Registration #:
Address: E. N r> y xp•: J34�
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Phone: � City: State: 11 Zip Code:
Contact/Rep. Name: Lq - Email:
AM -PJC -Q, Phone: Email:
General Contractor Authorized Signature:
A copy ofyour state registration/license is required to be on file. I this is t Date:
a photo co fy fy f f first time you have done work in the City of Rexb rg, pl se provide
p py o our license. I ou are unsure ifyour license is on file, pleas check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address:S Z r►� (A)
Description of Work: "-r� nFt
Project Description: 2eL2
• Total cost of project - materials and labor: $
• Check all that apply: _kW_P__
❑ Mechanical: Cost $❑ Electrical: Cost $�L/..0t, ❑ Plumbing: Cost $
ElFire Alarm: Cost $ —El Fire Sprinkler: Cost $
Note: Any contractors involved will need to fill out their respective application.
• Change of Occupancy? XNo ❑ 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, 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 of the 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 if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): ?L -4V --J5:" CA" -g4— Signature: ! 8
Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 A will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org
Permit Technician - (208) 372.2341
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America's FamilyCommunity35 North 1st East
Rexburg, Idaho 83440
PROPERTY LINES
Each site plan that is submitted to the City of Rexburg for the Building Permit process requires that property lines
are shown accurately. It is the Developer's responsibility to correctly identify on the site plan the location of these
lines in reference to the public right-of-way, other adjoining property lines, the street, other structures and all
utility lines. The Developer should find property pins that are still available at the lot in question. If these pins do
not exist or have become unrecognizable then a new survey should be performed.
Accurate property line information is a must for a timely review. In addition to finding existing property pins, legal
descriptions should be checked. The best way to identify property line location is with a land survey. The City of
Rexburg has aerial photos and a parcel line layer that can be checked, but they are only a tool and are not
guaranteed for accuracy. If you want to request a copy of your lot, see the front counter at the Community
Development Department.
I have read and understand the above requirements.
ture
Dat
C-1 rL�1
Printed Name
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
Revised 10/2016