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BP5002BUILDING PERMITAPPLI Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 /~ Electrical Application Date: ~ " ~ (~ l 2- Issue Date: ~~~~~~ Permit Fee: $ SG~ JOB ADDRESS I ~~ 3 So~.~-~-- LEGAL 1' DESCR. LOT iNO.) l I ' ,\ IVI lpU W~ ~ ' BLK. ~ ~ TRACT ^ SEE ATTACHED SHEET / ~ c Q~ ~~/- /- ~~j ,('~ J _1 2. OWNER '~~ rl ~ _2 ~~ l C31~1C~1. I ~ 10M3 AJ C~ S ~' Lam'' Q, l ~ / l.C= ICJ ~U-0 r ~~E 3. CONTRACTOR MAILADDRESS PHONE LICENSE NO. SGLr~2 USE OF BUILDING 4. ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 5. Class of Work: NEW ^ ADDITION ^ I 6. Describe Work: ~ t~ ~. ~ a. ~ C~.-1- ]. Sq. FOOtage Of StrUCture (Including Basement and Garage): 5o I $, Change of Use From: Change of Use To: g, Valuation of Work: $ (Z~j , OU 1~. FIOOdplaln: Floodway Yes ^ No ^ Dev. Permit Elev. Cert. Fringe Yes^ No ^ BFE 11. Current Zoning: 12. State Fire Marshall Required: Yes ^ No^ 13. Special Use Permit Required: Yes ^ No ^ 14. Variance Required: Yes ^ No ^ 15. Minimum Setbacks: Front Side Rear_ 16. Sidewalk Required: Yes^ No ^ Waiver Approved BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY NOTICE Separate permits are required for electrical, plumbing, heating, ventilating and air condi- tioning, and septic systems. By my signature below, I achnowledge that payment of the building permitapplication fee does not constitute issuance of this building permit. I further agree that construction covered by this permit application shall not be commenced until I have received a copy of this application form signed by the Building Inspector and stamped 'APPROVED'. I hereby agree to perform the proposed work in accordance with the specifications setforth above and in accordance with the codes~ordinances of the City of Blair and the State of Nebraska. I understand that this permit is void if work is not commenced within 180 days qr i not co~pleyed within 2 years o~,d~te of issue, ~ SIGNATURE OPOWNER~CONTRACTOR OR AUTHORIZED AGENT Site Plan Attached Complete Plans Attached ^ Approximate Com etion Date Inspections Required and Fees Utilities Sewer Tap Water Tap Sewer Water Service Septic Remote _ ng Framing ~Z7-cjz S~rz, .~ Fixtures CATION Permit N® 5 0 0 2 Drywall Final ~ Temporary Service Rough-in_ Final Ground Work Permanent Service Mechanical - ABC _ Plumbing SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Appro d By: ~ , c~.-r ~-~--• POUNDS NH I (9: tl191f, Nt ~'~-1 ~~ p g ~ ~~n~~ J ~~ © ~Q~ ~~ `~ ~ ab ~ ~~~ ~• C~' ~~ ,! ~ a ~d ~~ . ... (/ `--' A ~~~~ ~-~~