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BP5308BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Permit_ r ~~ C! Application Date: `~'" ~ Z ~-~ Issue Date: ~~ ~~ ~ ~~ Permit Fee: $ J JOB ADDRESS ' ,s%~ I ~~ W I I ~L~,r~ s~~~ -~ LEGAL LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET 2. OWNER nUv~~ ~~\C~/ MAILADDRESS ZIP PHONE `i / ~. MAIL ADDRESS PHONE LICENSE NO. CONTRACTOR USE OF BUILDING 4. PAIR ^ MOVE ^ REMOVE 5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ RE P 1 6. bescribe Work: r i . '~i _ C.i'1 ~- J~~~-e-~~ ~ /~-Q _ - ~ 1~.~'~.7-~ ~ C-~~,L1' ~' ~'C,Z/Z(.~ 7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): $. Change of Use From: Change of Use To: g, Valuation of Work: $ ;S C~C~ - CJC~ Floodway Yes ^ No ^ Dev. Permit 1t2 Floodplain: Fringe Yes^ No ^ BFE EIev.Cert. 11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^ 12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date --J~= ~ /~~ ~ ~ ~ ~~~ Inspec#ions Required and Fees 13. Special Use Permit Required: Yes ^ No ^ Utilities Sewer Tap Water Tap 14. Variance Required: Yes ^ No ^ Sewer Water Service 15. Minimum Setbacks: Front Side Rear Septic Remote 16. Sidewalk Required: Yes ^ No ^ Waiver Approved Building APPLICATI - NN ACC TED BY `~ ' PLANS CHECKED 8Y APPROVED FOR ISSUANCE BY Footings Drywall ~/ , (~/1~~~ Y~_~ (before finish) _ NOTICE Framing Final ~T ~~ ~~`~~ 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 Electrical 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 Rough-in Fixtures have received a copy of this application form signed by the Building Inspector and stamped 'APPROVED l ~ ~Y~ ~ ~~~ `=~ Fi . I hereby agree to perform the proposed work in accordance with the specifications setforth na permanent Service above and in accordance with the codes~ordinances of the City of Blair and the State of Temporary Service 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. Mechanical .~-~c;~(~«~ ~ Ci~~~ ~~-/~- - 9__3 Rough-in ABC SIGNATUA OF OWNERJCONTRACTOR OR AUTHORIZED AGENT DATE 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: 5308 YVUNUS YHIIi: HI91r, Nt BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Permit_ Application Date: j~~ Z~~I~ Issue Date: ~- f ~` I~~ Permit Fee: $ l~ ~~ JOB ADDRESS ' ~~ / ~ ~, / ~~~ / ~~. L 7 ! 1 . LEGAL DESCR. LOT N0. YG /,j J. B K. - TRACT J,~ _ J~j •- j ~ ^ SEE ATTACHED SHEET OWNER MAIL ADDRESS 2. ~c}vc C~/~ ZIP PHONE CONTRACTOR MAIL ADDRESS 3. ~)C~u`C ~~~ PHONE LICENSE NO. USE OF BUILDING ~ 4. 5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: ~ , (/ ~/~ ~ ' ~ ~~~U~ n G ~ j~ 7. Sq. Footage of Structure (Including BasamaM and Garage): 8. Change of Use From: Change of Use To: g, Valuation of Work: $ Floodway Yes^ No ^ 10. Floodplain: Fringe Yes^ No ^ Dev.Permil BFE EIev.Cert. 11. Current Zoning: 12. State Fire Marshall Required: Yes ^ No^ 13. Special Use Permit Required: Yes ^ No ^ 14. Variance Required: Yes ^ No ^ Site Plan Attached ^ Comp~te Plans Attached ~] Approximate Completion Date ~ k ~-/'try ~ . ~~~ Inspections Required and Fees Utilities Sewer Tap Water Tap Sewer 15. Minimum Setbacks: Front Side Rear 16. Sidewalk Required: Yes^ No ^ Waiver Approved _ 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 wnstitute 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 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. SIGNATU OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Water Service Septic Remote Building Footings Drywall (before finl~h) Framing Final Electrical Rough-in - Fixtures Final ~~~-~-X\' Permanent Service Temporary Service Mechanical Rough-in ABC _ Final Plumbing Ground Work Rough-in Final , WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT 5309 Comment: Approve By: