BP4994BUIL~~~ PR1VhI~' aPI~LICAT10~1
JurisdictionQf City of Blair, Nebraska
218 South 16th Street.
Blair, Nebraska 68008
(402) 426=4191
Application Date: ~' ~~'~~ Issue Date:
Permit
~4~ ~ 4994
Permit Fee: $ ~ S - O~
JOB ADDRESS ~~ 11 (( ~~ l~
~~ Ivy 2-`1~~ Y~~-
LEGAL
1 ' DESCR. LOT N0.
~ BLK. TRACT
C.C( ~5E-~ ~'I fnQ~~ ^ SEE ATTACHED SHEET
2, OWNER ~' MAIL ADDRESS ZIP PHONE
a r m F~.y 50.,E-~A y Z~ s~ I I -r ~
r3. CONTRACTOR ~~ I t ~ ~ _ I ~ ~ ~ IMAIL A R~ ~ ~ ~ ~ ~~ ` ~ ~~~n~ (; ~ J r/ CE~NO.
l (Y ~ I/ G `/ Lr
USE OF BUILDING
4.
5. Class of Work: ~ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~ ~~ ~~ ~~ , -~li5~l l ! pLSt.C`~-
], Sq. FOOtage Of StrUCture (Including Basement and Garage): r
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ <~, ~ ~/ Gf• ~ ~
10. Floodplain: FI°DawBy Yes ~ No ^
Fringe Yes^ No ^ Dev. Permil 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^
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~ ' (~ ~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ^ No ^ Waiver Approved _
ICATION ACC PTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE 8Y
2~ n~c~
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,.) 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 set forth
above and in accordance with the codes~ordinances of the Gity of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 1 SO days
or is not colleted within 2 years of date of issue.
OF OWNERfCONTRACTOR OR /~~LYFIORIZED AGENT DATE
Septlc Remote
Building
Footings Drywall
(before finish)
Framing Final
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: Approved By:
POUNDS PRTG: Bletr, NE Rev. 10191