BP5469BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 4 6 9
(402) 426-4191 Permit l
Application Date: ~ ~~ Issue Date: Permit Fee: $ / z
JOB ADDRESS
LEGAL
1 • DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER
2. MAIL ADDRESS ZIP PHONE
CONTRACTOR
3. ~'l r C CL U MAIL ADDRESS PHONE
/~ ~ti~ ~ ~ LICENSE N0.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~.~G . ~~~ ~~~~~s ~ L ~~-CLS-s G,_ ~~C~C~f
~/
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): 1 ~ /~' l ' c ~~`~
r7
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodway Yes^
Fringe Yes^ No ^ Dev.Permit EIev.Cert.
No ^ BFE
11. Current Zoning: Site Plan Attached. ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date
Inspections 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
A N AC EPTE 8Y PLANS CHECKED BY APPROVED FOR ISSUANCE BY FOOtIngS Drywall
(before finish)
NOTICE Framing Final
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 ElectfiCel
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 crommenced until I Rough-in g ~ Fixtures
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 Final
~ Permanent Service
above and in accordance with the codes~ordinances of the City of Blair and the State of Temporary Service
Nebra ka. I understand t his permit is void if work is not commenced within 180 days
o ' o completed within ears d of issue.`3`~,L„ McChanic8l
~, GRAS Cf3 Rough-in ABC
SIGNA UR 0 OWNER~CONTRACTOR 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 YOI~R PERMIT
POUNDS PRTG: Blalr, NE ' Rev, 10/81