HomeMy WebLinkAboutAPPLICATION - 19-00192 - 1145 S 2nd E - AT&T Cell TowerInspections 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
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Addition
For Office Use
Permit Number: ____________________ Zoning: ________________________________
Application Fee: ྅ $1000/Building
1. Property Owner
Name: ___________________________________________________________
Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________
Phone: _____________________________________________ Email: _____________________________________________________________
2. Applicant
Name: __________________________________________________________ Role: (Owner, Tenant, Contractor, etc.) _______________________________
Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________
Phone: _____________________________________________ Email: _____________________________________________________________
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 City of Rexburg, please provide
a photo copy of your license. If you are unsure if your license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address: _______________________________________
Project Description:
x Square footage of addition: ___________________
x Total cost of project - materials and labor: $_____________________
x Check all that apply:
྅ Mechanical: Cost $____________
྅ Fire Alarm: Cost $____________
྅ Electrical: Cost $____________
྅ Fire Sprinkler: Cost $____________
྅ Plumbing: Cost $___________
Note: Any contractors involved will need to fill out their respective application.
x Change of Occupancy? ྅ No ྅ Yes: New occupancy: _____________________________
x Other Comments (if any): _______________________________________________________________________________________________________
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): ___________________________________ Signature: _____________________________________________ Date: ___________
BUILDING PERMIT FORM
Updated 10/2016 200