BP5305- BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 -
Application Date: ,~~ ~~ '~~,~ Issue Date: ~ ~~ ~.~'" ~~~ Permit Fee: $ ~ ~
JOB ADDRESS i ~`t ~ r
F- C ~ t~
1. LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
OWNER ~ ~
2. MAILADD ESS ZIP PHONE
CONTRACTOR ~~~ r/l, ~ Jc,
~. `Kl J CAILADDq S
~~~ C
~ J~' f~PHONE
Vrn / y LICENSE NO.
~P 0 ~ ~~~ ~~~
USE OF BUILDING
4.
5. Class of Work: [NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~Q- _r, Lf ~ ~ ~ ~ ~ ~-'C ,~ ~ -
7. Sq. Footage of Structure pnduding easement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ( ~ ,
10. Floodplain; Floodwey Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit
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
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
Site Plan Attached .Complete Plans Attached ^
Approximate Co pletion Date ~[~~ /
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Dr
r lu-
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge 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'.
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~ot completed within 2 years of date of issue.
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
Framing
Rough-in
Final
Temporary Service
'~ Y/~' 3
Fixtures
Permanent 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
Permit
5305
~I
Comment: Approved ~
~...^^-
,'"< ~1'~?S~I
.. ~~ FE~uc~ma:
MEMBER
DATE
NAME `
ADDRESS ~ ~~e~
~1'OS• ~nC Br rro~s., Inc. Broski Bros., Inc.
915 Far 7320 "F" Street
~~E~S Kansas City, ouri'641 Omaha, Nebraska 68127
_ "-I ~ 1 ~ FENCE LINT TO BE CLEARED AND READY FOR INSTALLATION OF
i
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tt.ICTeI I eT I ~`~~ ~ d.3..-~/ vlJc^~'~..~r ~ l ~ ~/ Yk 1 / 5 1 1.V ~ \
~•"'°
C-J
"FRONT"
MATERIALS & INSTALLATION COMPLETE
Underground utilities must he marked, otherwise Broski Brothers, Inc, is not responsible or liable for damages to said utilities
You are hereby outhorixed to furnish and install the above described fencing at the prices and upon the terms and conditions specified hereon. I (we) accept
lull respomib iliiy for the location ohall property hoes, and I (we) hereby co em to Company's entry upon the property where the tenting is to 6e installed and
to Company's removal of said fence, without notice, it the contract price is not paid in lull when due. I (we) hereby warram that I (we) a e in and are entitled SALE
to possession of the property where the fence is to be installed, and I (we) hereby agree to indemnify Company and hold it harmless for any damages to said
property because of the removal of said fences a aloresaid. I (we) understand that all the terms and conddions set forth hereon a subject to acts of God,
govemmentol acKon, str&es, labor disturbances, stares, additional taxes, floods, eolthquakes, inability to obtain the materials described hereon, partial or total
imertup Gons, loss or shortage of producing, manulacmring or transportation fauliKez, or any ether cause beyond Company's control, whether o not similar to O~
any o! the causes spedfically enumeroied; and if performance in whole o n part rs prevented or hindered, or cosy is abnormally in sed a resuh thereof,
Company shall nor 6e fable for any losses, damages or delays o ned Ihe.eby, and performance hereunder shall bee used rwBhout sliobdity on Com-
pany's part I (we) further understood that this order constitutes thec emire agreement between the parties in reference to the materials described hereon.
TER
DATE
X
X
w w r w
f
l.p lpt Lone.~2.~~~Wa11
GATE POSTS
Long Wall
GATE
Height Frame
GATE
Height Frame
GATE
Height Frame
SIGN ATURE JIC,NA I UKt
Company agrees that all work performed will be in accordance wish the drawings, specifications, terms and conditions specified above. This order is subject to acceptance at its Hr
Oflice by a duly authorized representative of Broski Brothers, Inc. ~ '
ACCEPTED: ~! I~
LJ ~ (~~
_ ~~ ~ ~
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