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: