BP5312BUILDING PERMIT APPLICATION
' Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 312
(402) 426-4191 Permit
Application Date: ,~~-~ ~" f ~ Issue Date: ~~~ ~~f ~ Permit Fee: $ ~~C~~
JOB ADDRESS _ \f
„7 ~ ~ ~V' .5~ ~ LI~
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
~{''1 ~te ~~ S ^ SEE ATTACHED SHEET
OWNER ~/~''~AIL ADDRESS
2. C ~c ~d ~~/l.~l~_` ZIP PHONE
3. CONTRACTOR . AILADDRESS n PHONE ~ ~ ~ LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ ~
c~~ ~ ~ cT G~~~
C~ ~ ~ ~,
7. Sq. Footage of Structure pRGudiRg BaSemBRI and GaragB):
$. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~(n Q~1 ~ `~
Floodway Yes ^ No ^r Dev. Permit
10. Floodplain: FriRgs Yes^ No ~~ BFE
EIev.Cert.
11. Current Zoning: ~~ k'-
12. State Fire Marshall Required: Yes ^ No~
13. Special Use Permit Required: Yes ^ No [~
Site Plan Attached ~ Complete Plans Attached ^
Approximate Com~ etion Date ~~ ~Cs~_ l
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
14. Variance Required: Yes^ No[~-~
15. Minimum Setbacks: Front Z~ Side ~ Rear
16. Sidewalk Required: Yes^ No laiver Approved _
PLANS CHECKED BY 1 APPROVEIJ.fiOR ISSUANCE BY
NOTICE
Separate permit 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'.
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 i pleted within 2 year dat of issue.
IGNATUR WNER/CONTRACTOR R A HORIZ NT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Sewer
Water Service
Septic Remote
Building
Footings ~~~ ~ ~" ~ ~ Drywall
(before finish) ~2`~,~g 3
Framing `~ Final '°~~' ~~-~~
Electrical
Rough-in
Final
Temporary Service
Fixtures
Permanent Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE}THIS IS YOUR PERMIT
Comment: Approve Byn n ~~ , \ ~~
POUNDS PRTG: Blalr, NE Rev. 70/81
116 ~~9 ~ Fc~npi9R
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