BP4829BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 ~° 4829
(402) 426-4191 Permit - - - -
Application Date: ~-.Z~- 9L Issue Date: ~ `:3r~~~ Permit Fee: $ /~~
JOB ADDRESS
LEGAL
1
DESCR. LOT NO.
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Go V BLK. TRACT
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~ ~ a I 1 ^ SEE ATTACHED SHEET
2, OWNER -
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,3. CONT ACTOR MAILADDRESS PHONE LICENSE NO.
USE OF BUILD G
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5. Class of Work: ~I NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. FOOtage Of StfUCture (Including Basement and Garage): ~~x /~~ ~
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ vZS~
Floodplain: FI°oaway Yes^ No Q
10 Dev. Permit Cerl.
Elev
.
Fringe Yes^ No ^ BFE .
11. Current Zoning:
N
12. State Fire Marshall Required: Yes ^ No®
13. Special Use Permit Required: Yes ^ No Q
14. Variance Required: Yes^ No'~
15. Minimum Setbacks: Front ~ ° Side ° Rear ~
16. Sidewalk Required: Yes^ No ^ Waiver Approved
AP~TI~ N~ACC PTED BY I PLANS CHECKED BY I APP~gV,~D,FOR ISSUANCE BY
~X./l NOTICE ,.~J~ _
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 setforth
above and in accordance with th odes~ordinances of the City of Blair and the State of
Nebraska. I un er and that thi pe mit is void if work is not commenced within 180 days
or is not comple d ithin 2 ye s f date of issue.
-1 ~ r
SIGNATURE O WNERiCONTRACTOR ORAUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date a ~~"~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~~~ 3~y
Electrical
Rough-in Fixtures
Final +//~~S ~~2-- Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv d • t ~~
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