BP5435BUILDIt~C PERMITAPPLICATIOI~
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
5435
Permit_
Application Date: ~ ' ~'~ ~ Issue Date: ~~ ~~~<<~ Permit Fee: $ j '
JOB ADDRESS ~ ~ y~ C ~^~ ~~
`Y
1_' ,
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~~ I ~r ~Q 1~.~ I MAILADDRESS ZIP PHONE
-
~ ~ . MAIL ADDRESS ~ ~h ~~. n ~~ ~ ~// 1 ~ v LIC~S~
3 CONTRACT i ~ ~ f
L,~f1 T~ 1 L' V
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~t. i-l (` m ~~ ..~ ~~C' S f
7. Sq. Footage of Structure pnauding Basement and Garage):
8. Change of Use From: ,' ~~trl r~ Change of Use To:
g, Val ~- 2070.00
Floodway Yes^ No ^
10. Floodplain: Fringe Yes^ No ^ Dev.Permit
BFE EIev.Cerl.
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 _
I APPL~ATION,A^ C.E~ / ~~l PLANS CHECKED BY f APPROV D F~SUANCE BY I
' NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and sir 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 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 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 not completed within 2 years of date of issue. n
SIGNATURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT _ , DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date 1 5 days
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building ,~~
Is rvwall C~/
Framing
Electrical '
Rough-in Fixtures
Final Permanent Service
Temporary S ice
Rough-in e ha is
ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve By ~ ~
o-----.
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