HomeMy WebLinkAboutAPPLICATION - 17-00409 - 290 N 1st E - Madison School District - AwningC I TY OF
REXBURG
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America's Family Community
BUILDING PERMIT FORM 201
updated 10/2016
BUILDING APPLICATION
Commercial Remodel
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: Application Fee: ❑ $100
1. Property Owner
Name: M iSevvx7 r
Address: icJ N'� City: State: ED Zip Code: 53�gV
Phone: c20 -_35 -30 Q Email:
2. Applic
Name: e Role: Ow ant, Contractor, etc.)
Address: D r- City: State: 2:Ln Zip Code:
Phone:3/3 )U Email: `y
Contact/Rep. Name:
3. General Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Name: Registration #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date:
A copy of your state registration/license is required to be on file. If this is the first time you have done work in the Cityof Rexburg, please provide
a photo copy 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: 5?qc) �J A,
Description of Work:
Project Description: P W- N0 Car—Ae " '
• Total cost of project - materials and labor: $
• Check all that apply:
N14❑ Mechanical: Cost $ WAD Electrical: Cost $ %1�a ❑ Plumbing: Cost $
ij//.4 ❑ Fire Alarm: Cost $ MRD Fire Sprinkler: Cost $
Note: Any contractors involved will need to fill out their respective application.
• Change of Occupancy?), 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, 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.
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Applicant's Name (print): 1�.e �d �� t� Signature: z~ Date: � z � 7
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