BP5387BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 3 $ 7
(402) 426-4191 Permit ~
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Application Date: ~- ~ ~~-~ ~ Issue Date: ~ ` ~ ~" C1 2 Permit Fee: $
JOB ADDRESS ' ^~ ~
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LEGAL
1' DESCR. LOT NO. LK.
B TRACT ^ SEE ATTACHED SHEET
OWNER
2. ~Gtvi CJL MAILADDRESS IP PHONE
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3. CONTRACTOR ,/~ r _ /~
/) (~~ MAI ADDRESS PHONE LICENSE NO.
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USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ e~ ~~2~ , ~ Cf~
7. Sq. Footage of Structure (IRduding easement ena Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
1~. FIOOdplaln; Floodyray Yes^
Fringe Yes^ No ^ Dev.Permit EIev.CeA.
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
APP,6ICATIOpdACCEPZED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate p mils 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 copyof this application form signed bythe 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 City 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 ye rs of date of issue.
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
Site Plan Attached ^ Complete Plans Attached U
Approximate Completion Date ~ ` r~' ~2
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing
Final
Electrical
Rough-in Fixtures
Final ~ ~~~ ~~ " ~7 ~`~ Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved B
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POUNDS PRTG: Blelr, NE
CITY INSPECTION SLIP'S
Inspection has been requested for ~ Z~ 7 ~ ~z-~~~~~~- -
' Location of building
Name of Company
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Type of Inspection
AC ~~ `
Date Time
Results of the Inspection are:
C ty Representative
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