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Home My WebLink AboutAPPLICATION & PLANS -18-00693 - 12 W 1st S - K-Lani‘s Ice Cream and DesertsC IT Y OF REXBIMG BUILDING PERMIT FORM 2 U2 (� Updated 03/2018 Americas Family Community BUILDING APPLICATION Commercial Tenant improvement Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Application Fee: ❑ $100 1. Property Owner (� Name: T�lv$*:A Address: q 101 L W 'Em-e_V a\ 9L Sk .12 ity: iSb 1 S -c_- State: Zip Code: S 3 7 b q - Phone: 2-06- 96LOO- 1 N-N-L•i Email: 60 . Q_\ r -P-e-'% c- rhoL c-zvy- 2. Applicant �`` Name: la"r �t l't2.Y1sk tv La`^ r Role: (Owner, Tenant, Contractor, etc.) Address: al I —14 K1. g600 w City: R R_'%AP State: =d • Zip Code: 'A 0 Phone: $ - 1 -,Leel Email: in-c�•h2EnS\� a7 A:1 GpvErl Contact/Rep. Name: 3. General Contractor 5C %M Under Idaho Building Code, a registered contractor must do the work for a Commercial Buildin %G % Name: Registration #: 2462oltsomi p,: 5 Address: �� 1 �, 'Ih&1. 5 }t so q City:��burq State: Sri• Zip Code: 12.5 y V Phone: 2G $ - SLe 9 - Z `t" 1 Email: Contact Re Name: So r. IM t- Yh \\ ;,. J G o 4 !,Ant, ': fl •� J +� � Contact/Rep. Phone: Email: , rn ., 2D8-5�q-2iti� ga;i. General Contractor Authorized Signature: � Date: A copy ofyour state registration/license is re ed to be on file. If this if the first time you have done work in the City of 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. -i. Project Description Address: 12 -IV\ Description of Work: Qu;\d W 0.\\5 ci,,�� e.�a,nq,c eU- WOO 17 Project Description: • Total cost of project - materials and labor: $ • Check all that apply: ❑ Mechanical: Cost $'Electrical: Cost $ j o• m Db Plumbing: Cost $ ObO, 171 Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $ Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? ❑ No K 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. APPI IrA FJT'c crr_nl nTr -- - •••• • •ru,a uvn AND Au 1 t1Ux1ZATION: 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): Rut4 t t Signature: 12--� Date: IZ S I $ =7z n the day the :ns on is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. www.rexhurg.org Permit Technician - (208) 372.2341 4_'0w. F f�zs; tc _ C I TY OF _ Building Safety Department REYBURG BUILDING PERMIT FORM 230 City of Rexburg Updated 03/2018 I 35 North 1St East '•<,, � 10 America's Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Plumbing For Office Use Permit Number: Plumbing Fees Paid ❑ 1. Property Owner Name: _D9si-:,n Qt•-etu ' T _a- nn Address: 9114 w • FCity: State: S el. _ Zip Code: OO3 L 4 b Phone: 2-0 8 - Tt2O - !:7 Email: o, I • e ow. 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #:/''-%.> Exp.: Address: rt{.t%(�-lam %f _.,, ;;.a City:r;�J +� State:_ Lam: _Zip Code: Phone: �Ot) .ern Email: Contact/Rep. Name: = 1. �, � Phone: _3,44'-44L�f) Email: Plumbing Contractor Authorized Signature: :,, /�/, �- Date: ' y A copy ofyour state registration/license is required to be on file. If this is the first timeyou 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. 3. Project Description Address: 12- "" W I S� s Description of work: P—It :,1 Wf roject Cost: $ 31 coo. °O APP1.1CANTN 1Z1CNATl v a -*,e/ Cost of project: Calculation for inspection fee: If project cost is between $0 to $10,000 then: (Cost of project * 2916) + $60 If project cost is between $10,001 to $100,000 then: ((Cost of project - $10,000) * 1%) + $260 If project cost is greater than $100,001 then: ((Cost of project - $100,000) * Y2 %_)+ $1160 tL-1ut tau l ievlew fee is required which is 10% of the calculated inspection fee -, ---- -- - • • • ,.,11. uuuer penalty o[ 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. (VOTE: 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): _ '�v t--- S \I_ Signature: _ & �"O-Q-�I Date: -r x caUm a besxe 8 A!1 on the _::e :nspector is requested- Inspect -.on requests called in after 8 AM will be scheduled for the next business day. Y -'—� -ati.a..-exbur g.org Permit Technician - (208) 372.2341 11ei 6W111 U13U ae a plan review fee totaling 10% of the above 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 mein 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 urg 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 oft he s of t he 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); u t'�- n l e- Signature: '"�C��v�4� �,` 12 Date: - -- _-e aai -= besa: e n A.M a- the day -;cecton s requested. Inspection, requests called in after 8 AM will be scheduled 3for the next business day. p —� °rg Permit Technician - (208) 372.2341 CITY o 1? Building Safety Department RF.XBIJRG BUILDING PERMIT FORM 22O City of Rexburg Updated 03/2018 America's Family Community 35 North 1St East Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Electrical For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner 1 T n Name: �+S *, Qf etc -t / 1 K -2Y- ((Cost of project - $10, 000) * 1 %) + $260 Address: 041q'_@ w . S.rn.P r&0- 53r. 12° City: gu 5 t State: Sd • _ Zip Code: S'1440 Phone: 2O S - $tp o - 7 Lf '% Ll Email: D . 2\ G -2£%,n c If project cost is greater than $100,001 then: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: _��: j�mo. ti \,t L� r; State License #: 'L � 013 9 Exp.: 4 j q 161 Address: 414cl- City; i2�eacb��a State: Td. _Zip Code: 834 17 Phone: 20% - 3`1'O - OlQ 1p Email: �D - \ c;% 5 Gla VV'- Contact/Rep. Name: ` _odd L :Shrn4.1 Phone: %P - 390 Email:a7 cj \ Electrical Contractor Authorized Signature: Date: A copy ofyour state registration/license is required to be on file. th' is e first timeyou have done work in the City of Rexburg, please provide a photocopy ofyour license. Ifyou are unsure ifyour license is n e, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: 11k- W; S Description of work: pw�iI A a - �a-o P\'11 ; S : A, w 4a01 Project Cost: $ Too '0 J 11ei 6W111 U13U ae a plan review fee totaling 10% of the above 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 mein 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 urg 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 oft he s of t he 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); u t'�- n l e- Signature: '"�C��v�4� �,` 12 Date: - -- _-e aai -= besa: e n A.M a- the day -;cecton s requested. Inspection, requests called in after 8 AM will be scheduled 3for the next business day. p —� °rg Permit Technician - (208) 372.2341 Cost of project: Calculation for inspection fee: If project cost is between $0 to $10,000 then: (Cost of project * 2%) + $60 If project cost is between $10,001 to $100, 000 then: ((Cost of project - $10, 000) * 1 %) + $260 If project cost is greater than $100,001 then: ((Cost of project - $100,000) * 1yz%) $$1160 11ei 6W111 U13U ae a plan review fee totaling 10% of the above 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 mein 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 urg 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 oft he s of t he 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); u t'�- n l e- Signature: '"�C��v�4� �,` 12 Date: - -- _-e aai -= besa: e n A.M a- the day -;cecton s requested. Inspection, requests called in after 8 AM will be scheduled 3for the next business day. p —� °rg Permit Technician - (208) 372.2341 f-(�A' poor 0Vf- ,fY-