BP5205BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date '~ I
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Application Date: ~ ' ~~°~~ ~ Issue Date: ~ "Z°"1' `~ Permit Fee: $ -. C? 1
JOB ADDRESS
.~ C/
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2, OWNER MAIL ADDRESS ZIP PHONE
CONTRACTOR
3. ~~ >r, _"~ .S~Ec~~~c~ ~l ~~ MAIL ADDRESS 1
r 1 Z ~~ ~ ~y PHONE LICENSE NO.
I~~ C.~~1 ~ Colu~r~ lJ vS l~~ ~ ~(~Q f
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~ rC.~1Gt~CS~ (~.,~~ C~~ ' ~~ L~~
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodway Yes ^ No ~
Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert.
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 _
ACCEPTED BY f 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 permit application 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 set forth
above and in accordance with the codes~ordinances of the Ciry of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not completed within 2 years of date of issue.
SIGNATURE OF OWNERiCONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Septic
~ -
Permit N 5 2 0 5
Remote
Building
Footings Drywall -
(beforefinish)
Framing
Rough-in Fixtures
Final Permanent Service
Final
Electrical
Temporary Service
Mechanical A ,~ c
Rough-in ABC ~~~^' °'~ "~
Final ~~ ~~~'
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: App ve B : ~
t~..-.
CATION
POUNDS PRTG: Blelr, NE Rev. 10r91