BP5179BUILDING PERMITAPPLICATIO~fiI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 No
(402) 426-4191 Permit
Application Date: l2' ~ ~ ~2 Issue Date: ~ ~"Z~ c Z-- Permit Fee: $ s- C~
JOB ADDRESS ~ ~~ `/ ~~U)~ ~ ~~,
1 . LEGAL
DESCR. LOT NO. BLK. ~
S~ TRACT
^ SEE ATTACHED SHEET
2. OWNER ~ 1- /~ ~ ~ ~ MAILADDR~CVM n ZIP , `~ _ ~ ^~j ~ PH ~~~ ~// _
y C
I `~-
YV
LICENSE NO.
PHONE
MAILADDRESS
3. CONTRACTOR
S ~~~~.
USE OF BUILDING
4.
5. Class of Work: [NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~ ~ _ C _ ~ ~ ~ 0% ~/ C~`Li
], Sq. FOOtage of StrUCture (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ as 5, r~U
10. Floodplain; Floodway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit Elev. Cert.
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 TI~ON AfC~CEPi E~ 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 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 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 years of date of issue.
SIGNATURE OF OWNER~CONTRACTOR OR
SIGNATURE OF OWNER (IF OWNER BUILDER)
AGENT DATE
~2 / Y
DATE
Final
Site Plan Attached Complete Plans Attached ^
Approximate Com letion Date ~~ 3~` q~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Water Service
Septic Remote
Building
Footings D all
( ef~ish)
Framing ~ al' G~ 3 Z 3
~ Electrical
Rough-inf Fixtures
Final Permanent Service
Temporary Service
Rough-in
Final
2 Ground Work
Rough-in _
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Mechanical
- ABC _
Plumbing
5179
~<~
Comment: Appro ed y ~ c~~
,.....~.... ....~., ..~_~_ .~.- Rev. 1018
CITY OF BLAIR
Application i'or Building Permit
PLOT PLAN
Address ; ;~~ ~~;~ r~f°o~i~` -a~- Date
Legal Description: Lot atr ~o~- ~ Block ~ Addition ~ ~ ~"
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc,, and property lines.
Is this a corner lot? ~~-~
~F
Y
f
rC
F
:ndieate North
_ _Center Line_of _ _ _ Street_
Applicant ~~
~~ C ~'1 a ; ~ ~; ~ ~~ '~`-ern c ~
,- ~~~~~s~~ ~~~w. .~ ~ Sd1;~ C~64 ~en~e,