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Home My WebLink AboutAPPLICATION - 19-00119 - BYUI - Hart Building MEP RemodelCITY OF REXBURZG Amerfca' Family Community Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 COMMERCIAL REMODEL/TENANT IMPROVEMENT APPLICATION CHECKLIST The following items should be completed before you submit your building permit application. *Reasonable accommodations will be made upon request. Submit the Following Documents: ❑ 3 sets of building plans - stamped by a licensed professional. Include the following as applicable ❑ Foundation Plan, Floor Joist Layout, Floor Plan, Roof Layout, Truss Details, Sectional Views, Front, Back, and Side Elevations, Mechanical Layout, Stair Details, and any details required to illustrate special construction. ❑ Electrical panel layout and calculations included with building plans. ❑ Exterior Lighting Plan including photometric layout. ❑ Structural Calculations (if applicable) - stamped by a licensed Engineer ❑ Digital Plans (PDF Format - can be submitted by USB, CD, or Dropbox) ❑ "Copies of any Contractors' State License if not on file already. Complete the Following Forms ❑ Permit Policies Acknowledgment signed ❑ Building Permit Application signed by a registered General Contractor ❑ Mechanical Permit Application signed by a registered Mechanical Contractor ❑ Electrical Permit Application signed by a licensed Electrical Contractor ❑ Plumbing Permit Application signed by a licensed Plumbing Contractor ❑ Fire Alarm Permit Application (if applicable) signed by a registered professional ❑ Fire Sprinkler Permit Application (if applicable) signed by a registered professional ❑ Subcontractor list filled out ❑ Affidavit of Legal Interest signed by owner ❑ Notifications Distribution List ❑ Business Use Summary Completed Subdivisions: If you plan to build in a subdivision please check the Rexburg Development Code for any requirements such as property setbacks, architecture board approval, etc. This information is available at http://rexburg.org/pages/development-code. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 C IT Y OF REXBURG Arnericas Firmly Community PERMIT POLICIES ACKNOWLEDGMENT Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 The City of Rexburg Building Safety Department is determined to provide excellent customer service. In an effort to help you understand the City of Rexburg Permit Policies, listed below are several policies which you are required to know prior to proceeding with your project. Any construction within the City of Rexburg which requires a permit shall not begin until an approved permit is obtained. If you do not have a Pink Building Permit signed by the Building Inspector, then you do not have an approved permit. o Building without the pink building permit signed by the Building Inspector will result in double fees to be assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City Initials Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations may be issued. No building may be occupied without receiving a signed Certificate of Occupancy. o If a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the occupants may be evicted. Initials Scheduling inspections is the responsibility of the applicant and their contractor. Inspections need to be called into the hotline and not to the inspector. Inspections called in later than 8 AM will be scheduled for the following business day. o If an inspection is not done, the inspector may require any measures to be taken to allow him to correctly perform the inspection. (Example: If the electrical rough in inspection is not done and the sheetrock has been Initials put up, the inspector may require the sheetrock to be removed in order to perform the electrical rough in inspection.) Construction on any project can begin ONLY when you have received a Pink Building Permit from the Building Department. Occupancy of any structure can begin ONLY when you have received an official Certificate of Occupancy from the Building Department. These documents must be signed by the appropriate authorities from the City of Rexburg. Any approvals can be verified by calling (208) 372-2341. l o Even if you hear from an inspector that 'you're good to go', ultimately if you do not have a Building Permit or Certificate of Occupancy, the above policies will be enforced. Initials It is your responsibility to inform anyone on your project of the above policies. All sub -contractors will be held to this standard with no exceptions. o The above policies will be enforced to all, regardless if this information is passed on to them or not. Initials Applicant's Name (print): Andrew Wolford Signature: Date: 3/12/2019 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 Revised 10/2016 C IT Y OF REXBURG Americds Family Community BUILDING PERMIT FORM Z 1 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: Brigham Young University - Idaho Address: 525 South Center Street City: Rexburg State: ID Zip Code: 83460 Phone: 208.496.2664 Email: iohnsonagbyui edu 2. Applicant Name: Big -D Construction Corp Role: (Owner, Tenant, Contractor, etc.) CM/GC Address: 343 East 4th North Suite 112 City: Rexburg State: ID Zip Code: 83440 Phone: 208.709.9761 Email: andrew wolford(a)bia-d corn Contact/Rep. Name: Andrew Wolford 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Name: Big -D Construction Corp Registration #: RCE -4751 Exp.: 12/28/2019 Address: 343 East 4th North Suite 112 City: Rexburg State: ID Zip Code: 83440 Phone: 208.709.9761 Email: and rewmolford(a)big-d corn Contact/Rep. Name: Andrew Wolford Phone: 208.709.9761 Email: andrew.wolford0big-d corn General Contractor Authorized Signature: ' �a Date: 3/12/2019 A copy ofyour state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. if you are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 4. Project Description Address: 525 South Center Street Description of Work: Upgrade existing mechanical electrical and plumbing systems in the John W Hart building Project Description: 00 • Total cost of project - materials and labor: $ • Check all that apply: ❑ Mechanical: Cost $2,303,300.00 ❑ Electrical: Cost $156,400.00 ❑ Plumbing: Cost $ 32,000.00 ❑ Fire Alarm: Cost $ 16,000.00 ❑ Fire Sprinkler: Cost $ 383,590.00 Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? RflNo ❑ 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): Andrew Wolford Signature: ZLD Date: 3/12/2019 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 CITY O F REXBURG America's Family C.onimanity BUILDING PERMIT FORM Z 1 dpjt ted itl" 2016 BUILDING APPLICATION Commercial Mechanical Building Safety Department City of Rexburg 35 North 1st East Rexburg;, Idaho 83440 For Office Use Permit Number: Mechanical Fees Paid ❑ 1. Property Owner Name: Brigham Young University -Idaho Address: 525 S renter StrPPt City: Rexburg State: Idaho Zip Code: 83440 Phone: 208.496.1411 Email: 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: i.ewic f ornnratinn State License #: HVC C_4440 Exp.: _5/31/2019 Address: 15136 W Hunziker Rd City: Pocatello State: Idaho Zip Code: 83202 Phone: 208.238.1202 Email: kenvanlc�Irnrn cnm Contact/Rep. Name: Kenyan Lewis-,�.on08.238.1202 Email: kenyan@lcorp.com Mechanical Contractor Authorized Signature:Date: 3 - �g A copy of your state registration j license is rerl ired to b on jil . this is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure i r icense is on file, please check with the Permit Technician by calling (208) 372-2341. 3, Project Description Address: BYU-Idaho Hart Building S center Street, Rexburg, Idaho 83440 Description of work: Mechanical ❑ Project Cost: $ 2,303,300.00 • Fees for commercial projects are charged by cost: o First $10,000 = 296 + $60. From $10,000 to $100,000 =140 + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 140 of the remaining $5,000 = $260 + $50 = $310 total ee • There will also be a plan review fee totaling 1046 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 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): Signature:Date: 3 - C 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 �� 4t:xevR� �y G CI TY O F Ut '' REXBVR Amenras family wmmunity BUILDING PERMIT FORM 22U I BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 151 East Rexburg, Idaho 83440 For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner Name: Brigham Young University - Idaho Address: 525 S. Center St. City: RexburgState: ID Zip Cade; 83460-8205 Phone: 208.496.2664 Email: johnsona@byui,edu 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work far a Commercial Buildings, Business: Mountain West Electric, Inc. State License #: ELE-C-3802 Exp.: 12/31/19 Address: 586 West Highway 26, #1 City: Blackfoot State: IU Zip Code: 83221 Phone: 208.684.5463 Email: dbrown@mtnwestelec.com Contact/Rep. Name; Scot Wanstrom Phone: 208.681.5465 Email: swanstrom@m[nwestelec.com Electrical Contractor Authorized Signature: l—' �'9kLV Date: 3/7/15 A copy of yourstate registration/license is required to be on file. if this is 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. 3. Project Description Address: BYU-I Hart Building - MEP Remodel Description of work: Lighting and gear installation for building remodel ❑ Project Cost: $ 156,400.00 • Fees for commercial projects are charged by cost. o First $10,000 = 2% + $60. From $10,000 to $100,000 =1 % + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be 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 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): BtLC+ 12 a-jtC ___ Signature: --9A R� % - I � 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.nrg Permit Technician - (208) 372.2341 o� 4exeupc CITY OF Building Safety Department REXBURG BUILDING PERMIT FORM 230 City of Rexburg cy, upaazodto/zn1b 35 North 1st East '•<, r � . o America's Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Plumbing For Office Use Permit Number: Plumbing Fees Paid ❑ L Property Owner Name: _ Brigham Young University -Idaho Address: 525 S Center Street City: Rexburg State: Idaho Zip Code: 83440 Phone: 208.496.1411 Email: 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: _ Bingham Mechanical State License #: PLB-C-10702 Exp,: 9/30/19 Address: 4400 South Yellowstone Hwy City: Idaho Falls State: Idaho Zip Code: 83402 Phone: 208.522.4484 Email: jasonolson@binghammechanical.com Contact/Rep. Name: Jason Olson aho-08.313.6209 Email: jasonolson@binghammechanical.com Plumbing Contractor Authorized Signature. 3 G /� Date: A copy r7jyGitr state registration/license is required t e on Xif this is the first timeyou have clone work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyou license is on file, please check with the Permit Technician by calling (208) 372-2311. 3. Project Description Address: BYU-Idaho Hart Building Center Street, Rexburg Idaho 83440 Description of work: Plumbing & Hydronics ❑ Project Cost: $ 32,000.00 • Fees for commercial projects are charged by cost: 0 First$10,000 = 2% + $60. From $10,000 to $100,000 =1 % + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first$10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the information herein is correct and 1 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 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 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):rash D/s/Yj Si natu g Date: -� -- �--_ Inspections must be called in before SAM on the day the inspection is requested. Inspection requests called in after8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 �saezauac C �a CITY O F REXB BUILDING PERMIT FORM01 npda�M I0i2Gin ny - -- -- Americas Family Community BUILDING APPLICATION Fire Alarm Building Safety Department City of Rexburg 35 North 1St East Rexburg. Idaho A�44n For Office Use Permit Number: _. Fire Alarm Fees Paid ❑ 1. Property Owner Name: Brigham Young University Idaho Address: 525 S. Center St. City: Rexburg State: ID Zip Code: 83460-8205 Phone: 208.496.2664 Email: Johnsona@byui,edu 2. Contractor Business: Mountain West Electric, Inc. State License #: ELE-C-3802Exp.: 12131/19 Address: 586 West Highway 26. 81 City: Blackfoot State: ID Zip Cade: 83221 Phone: 208.684.5463 Email: dbrown@mtnwestelec.com Contact/Rep. Name: Scot Wanstrom phone: 208.681.5465 Email: swanstrorn@mtnwestelec.com Contractor Authorized Signature: Date: 3/7119 A copy of your state registration/license Is required to be onIle. If this is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. lfyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: BYU I Hart Building - MEP Remodel Description of work: Fire alarm addition for building remodel ❑ Fire Alarm System Cost: $ 16,000.00 • Fees for fire alarm systems are charge by cost: o First $10, 000 = 2% + $60. From $10,000 to $100,000 =1 % + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 to al f a • There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION. Under penalty of perjury, I hereby certify that t have read this application and state that the information herein 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): .Bi1vf _ 6rt.N/._r Signature:Date: `3-7'17 AS-.- _ ._-..___—.__ 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 C IT Y OF REXBURG OW America's Fatni(y Comn:ur:ity BUILDING PERMIT FORM4,02 Updated 10/2016 BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1St East RexburLy, Idaho 83440 For Office Use Permit Number: Fire Sprinkler Fees Paid ❑ 1. Property Owner Name: Bringham Young University - Idaho Address: 525 South Center Street CitY Rexburg ID State: Zip Code: 83460 Phone: 208-496-2664 Email: lohnsona@byui.edu 2. Contractor Business: 3-D Fire Protection State License #: FPSC-008 Exp.: 12/31/2019 Address: 6312 S. Burggraf Way Ci : Idaho Falls ID Phone: 208-525-8377' State: Zip Code: 83401 Email: State: Contact/Rep. Name: Kelly Bateman Phone: 208-525-8377 Email: kelly.bateman@3dfire.us Contractor Authorized Signature: Date: 3-8-19 A copy ofyour state registrationJlicense is requi ed to be on Erle. if this is the fast time you have done work in the City of Rexburg, please provide a photo copy ofyour license. If you are unsure if your license is on file please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: 525 South Center Street Description of work: Add fire sprinklers in remodel areas per scope of work. Number of Heads: ❑ Fire Sprinkler System Cost: $ 383,590.00 • Fees for fire alarm systems are charge by cost: o First $10,000=2% +$60. From $10,000 to $100,000 = 1 % +$260. Above $100,000=.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 =X310 total • There will also be 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 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): Kelly Bateman Signature: /l� a� Date: 3-8-19 Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will he scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexbtirg.org Permit Technician - (208) 372.2341 `F gF.!C8C'kr. CITY OF REXBURG -- C14W — America's Family Community SUBCONTRACTOR LIST Excavation & Earthwork: SIA Concrete: ,�Kk (�Wex Masonry: Aj /,4 Roofing: -7r- nom 5 7 ( � S o,� �j a, i•. �r'I Insulation: sJ 1A Drywall: A c -o- %-Ti L, Painting: As.PT-70 Floor Coverings: d-114 Plumbing: Lewis Corporation Heating: Lewis Corporation Electrical: Mountain West Electric Roof Trusses: '`//4 Floor/Ceiling Joists: .'-/ 14 Siding/Exterior Trim: Other: 14 Special Construction (Manufacturer or Supplier) Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 CITY or REXBURG OW America's Family Community Affidavit of Legal Interest State of Idaho County of Madison 1 � _ Name City Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) 4A{:j -Vl�,k t'� i Address State Building Safety Department City of Rexburg 35 North 1St East RexburLy, Idaho 83440 A. That I am the record owner of the property described on the attached, and I grant my permission to: Name Address to submit the accompanying application pertaining to that property. B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any claim or liability resulting from any dispute as to the statements contained herein or as to the ownership of the property which is the subject of the application. Dated this day of 20 1 `� x �1 Signature Subscribed and sworn to before me the day and year first above written. Inspection Hotline -(209) 372.2344 Notary P1lblic bf Idaho Residing at:a�e� r1) My commission expires: 9QL?( `) www.rexburg.org permit Technician - (209) 372.2341 Revised 10, 2016 C' I TY o F Building Safety Department REXBURG City of Rexburg OW 35 North 1St East America's Family Community Rexburg, Idaho 83440 DISTRIBUTION LIST Please provide the names and emails of anyone who should begetting automated updates for this project: Review Notes Name: Andrew Wolford Name: Kenny Rasmussen Name: Tyler Ames Name: Name: Inspection Tickets Name: Andrew Wolford Name: Kenny Rasmussen Name: Tyler Ames Name: Name: Email: andrew wolford0big-d com Email: krasmussen@big-d.com Email: tyler.ames(ftig-d com Email: Email: Email: and rew.wolford(@bia-d.com Email: krasmussen big -d com Email: tyler.ames big -d com Email: Email: Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 `t KV.X6C'Rr C IT Y OF Building Safety Department REXBURG City of Rexburg '►-- - 3S North 1St East .a,nericasFamily Community Rexburg, Idaho 83440 BUSINESS USE SUMMARY The following questions will help speed the review process along. Please take the time to answer all of them. Is this business occupying an existing building? Af Yes ❑ No Will the business be doing any structural/or remodeling changes to the building? 4Ves ❑ No Any changes to the electrical? Bfl�es ❑ No Any changes to the plumbing? i Yes ❑ No Any changes to the mechanical system? 41ves ❑ No Is the business type changing? ❑ Yes, it will change to A Is this business changing ownership? ❑ Yes INo Is the business registered with the City of Rexburg? iOYes, License #: ❑ No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? ❑ Yes eNo Will there be any cooking of foods? Will there be any deep fat frying? Will you have food disposal on site? Will there be sumps or floor drains in the facility? Will the business have any chemicals on site? S�� 2a8- -7DT- i74o / Applicants Signature Phone 3/12/2019 Date ❑ Yes ReNo ❑ Yes EeNo []Yes Ao olves ❑ No Url�es ❑ No I certify that the information that I have provided above is to the best of my knowledge accurate and true. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016