BP5083BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 N° 5 ~ 8 ~
(402) 426-4191 Permit
Application Date: ~ ~ " ~ `~ 2 Issue Date: ~ ~ " ~ ~ "~ ~ Permit Fee: $ ~(~ ~ U
JOB ADDRESS I ~ ~,~ C ~ , \ ~ ~ ~ , / "- _
1 ' DESCR. LOT N0. ~ ~ > //,s _ ~
~/ BLK. ~ TRACT ^
SEE ATTACHED SHEET
2 OWNER ~ r MAIL ADS ESS i C /~ / J ,~ ~ Z,If~„ , _ PHONE
3, CONTRACTOR ` MAILADDRESS
ClJ PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~-1 ~Z1.(J-e. _ ~/ (rl~ ~ ~(y~ ~~
], Sq. Footage Of StrUClUre (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~ OOC~- ~ ~
10. Floodplain: FlDOawBy 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
Site Plan Attached Complete Plans Attached ^
Approximate Co pletion Date _ /~ _/~" ~~
Inspections Required and Fees
Utilities
Sewer Tap _ Water Tap
Sewer Water Service
Septic _ Remote ,
11-(o-rl2° 5~~11 WorKtnq
Building
TION ACCEPT&D 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 bythe Building Inspector and stamped
'APPROVED'.
Iherebyagreet ~Jmtheproposedworkinaccordancewiththespecificationssetforth
above a Wince with thecodes/ordinances of the City of Blair and the State of
N r a: erstand that this permit is if work is not commenced within 1 SO days
o ' of co leted within 2 years of da e f is ue.
S ATURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
Footings Drywall
(before finish) _
Framing Final ~~ l ~~
~'~~ °== d
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
,~:,~...
POUNDS PRTG: Blelr, NE - Hev. lUr91
a~*
D
c~T3
~l
G
'ter
`~
~~
~`~~
~~
~ ~~
~~
°~
;~
T ~ ' d 80S98~FZQi~ ryuug as ~ ,Ls a i ~