BP4857BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 ~® 4857
(402) 426-4191 Permit - - - -
Application Date: 3 -2~ ~ Issue Date: ~ • Z 7' ~ Z Permit Fee: $ ~ •~
JOB ADDRESS ~ ~ ~ ~ ~ ~ C. ~~
1 , LEGAL
DESCR. LOT NO. l
l~ BLK.
3 TRACT
~'~~ (~2{'((~ ~^~n/
~eC.~vrv ^ SEE ATTACHED SHEET
OWNER ~ M LADDRESS
2. poi' > ~~e i~l ~
.5c~~ ZIP PHONE
~(Z(~~~~
3. CONTRACTOR ~' , \1~ ~ A MAILADDRESS
WV.l_Jrh, r~ir ~ r~VI
!-+) ~I-ONE~~M~ ~~ ~~ LICENSE NO.
]7"-~~L1 v ~V o
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ j ~ hQ`~~-~ -- i'(1 I
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ L(3C~ - ('(J
10. FIOOdplaln; Floodway Yes^ No ^ Dev. Permit
Fringe Yes^ No ^ BFE Elev. Cert.
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 _
TION 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 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 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 mpleted within 2 years of date o issue.
~~~
$ GNATURE OF OWNER/C NTR 0 OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~ y~ ~-~ ( 2
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~~J~~ /r//
Electrical `~`~w ~ Z ~ ~~
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS I~YOUR PERMIT
POUNDS PRTG: Blelr, NE Rev. 1091