BP4843BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 ~~' 4$43
(402) 426-4191 Permit - ' - -
ANplication Date: ~~ 9~ Issue Date:
3 -i ~~- 9z
o~
Permit Fee: $
JOB ADDRESS `~~~
/ ~~
LEGAL
' DESCR. LOT NO. ~
I
~ ~~p BLK. /~~
~<l TRACT ^ SEE ATTACHED SHEET
2. OWNE MAID D ~, ~ L~~
~. 1~ PHONE
3. CONTR9 OR MAILADDRESS PHONE
~~ LICENSE NO.
~ ~- 7~3
USE OF B DING
4.
5. Class of Work: ^ NEN/ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~-
7. Sq. FOOtage Of StfUCtUre (Including Basement and Garage): ~0 ~ -
8. Change of Use From: ange of Use To:
g, Valuation of Work: $ 3~ OG
10. Floodplain: Flooawey 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 _
ACCEPTED 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 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 bythe 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 wdes~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 i of co pleted fth' 2 ye rs d f issue.
SIGN OF OWNERJCONTRACTOR OR A ED AGENT DATE
Site Plan Attached ^ Complete PI ns Attached ^
Approximate Completion Date 3~~/~~/oL
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
~~
Sewer Water Service
Septic Remote
Building
Footings)/ ~' Z >..(~1~ Drywall
(before finish) ( n
~
~
Framing ',
Final .tom ~'{
f'
"`
"~
(
/
~
~J`'" ~~ 2~ /~Z
Electrical
.
Rough-in Fixtures
Final 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: Approve By: ~`
c~-.-..,
_....__ ____ ~. .... Rov 1!110
_1
r CITY INSPECTION SLIPS
Inspection has been requested for J Z ~
Location of Building
Nani~e of Company
On . ~,: ~°^..~
Type of Inspection
At ~ 12.~
ate Time
Results of the Inspection are: *~'/
City Representative