BP5341BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATI O N
Permit 5 3 41
Application Date: ~- ~- ~~ Issue Date: (~ `~0 ~~~ Permit Fee: $ /~`~
JOB ADDRESS ~~p
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~ I L' a ~..5 ,/~~ ~ I ~1 /~ M~ADDRE~ , SS n ~ ZIP
~_ PHONE
_ ~ ~~ / ~( PHONE
3. CONTRACTOR 1~1- ~MAIL~Dp~ESS ~
1 ,,/l[[//11 l1/1 '`7~Lll t, ,V~~/L_ ~~` C~~~ CENSENO.
7
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: e f~C~ /;~~~ ~ c ~~
7. Sq. Footage of Structure p~duding Basemem and Garage>:
$. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^ Dev. Permit
10 Floodplain: Fringe Yes^ No ^ BFE
EIev.Ced.
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
^
^ Approximate Completion Date ~~"~
No
12. State Fire Marshall Required: Yes
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ Utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No ^ sewer Water Service
15. Minimum Setbacks: Front Side Rear septic Remote
16. Sidewalk Required: Yes^ No ^ Waiver Approved Building
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
-~ lob (before finish)
NOTICE Framing Final ~'~-~3
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 Electrical
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 Rough-in Fixtures
have received a copyof this application form signed bythe Building Inspectorand stamped
'APPROVED'. Final Permanent Service
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
Temporary Service
Nebraska. I understand that this permit is void if work is not commenced within 1 BO days
or is ted ithin 2 ye ate of is e. Mechanical
16~~
Rough-in ABC
IGNATURE OF OWNER)CONTRACT ~0 AUTHORIZED ENT DATE Final ~~ U ~
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv By,; ,~s ~~
_....-- ---- -...._ ~/~ o.~ .~
CITY INSPECTION SLIPS
Inspection has been requested for ~~ ~~ ~ '' ~~~~ ~"I/~-
Location of Building
By ,,,~-~C` c`~.,~ S ~', 1~~. X7'1
~ ~~ ~
Na e of Company ~A f/
On ~~L.1Z~ ~~ ~ J ~~GU~ ~ ~ ~~,/l
Type of Inspection
At ~' ~ ..c3 s~-of~
Date T'me
Results of the Inspection are: ~ ", \
City epresentative
~.
'~