BP7234_ ~ B ILDING PERMITAPPLI
A P P R OV D Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit
7234
Application Date: ~ Issue Date: ~ e " ~ ~ Permit Fee: $ ~d • ~
JOB ADDRESS n '' '' ``~~
~~ / / ~ r/l_JlJ
LEGAL
1. DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2 OWNER ~ ~/ / _ / ~~ ~ ~ MACILADDR~ ZIP PHONE
r / ~
MAILADDRESS PHONE LICENSE NO.
3 CONTRACTOR
>G~~
USE OF BUILDING
4:
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE.
6. Describe Work: ~~S ~ ~ S(/~~ ~~-~ ~ 7 ~~~
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ , ~~
10. Floodplain: Floodway Yes ^ No ^ Dev. Permit Elev. Cert.
Fringe Yesl~ No ^ BFE
11. Current Zoning: Site Plan Attached [~ Complete Plans Attached ^
State Fire Marshall Required: Yes ^ No^
12 Approximate Completion Date ~~ " ~ " 9C~
. 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
APPLIC ION ACC TED 8Y PLANS CHE~KED_@Y APPROVED F NCE BY Footings Drywall
~ (before finish)
r ~
NOTICE Framing Final '~ ~ `~ ~
y~
Separate ermits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge that payment of the
Electrical
building permit application fee does notconstitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I
hayereceivedacopyofthisapplicationformsignedbyiheBuildinglnspectorandstamped Rough-in Permanent Service
'APPROVED'.
Iherebyagreetoperformtheproposedworkinaccordancewiihthespecificationssetforih Final i~ Tem ora _ Service
p ry
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,
is not completed within 2 years of the date of issuance, or if work is abandoned for six (8) Mechanical
months or longer, whichever is earliest. Rough-in ABC
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
v y~ n
~Xy~. ~ Final
Ground Work
Plumbing
SIGNATURE OF NER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THI~I~~I~ ~ ~- f1
Comment: ~ Approved By:
Rev. OB!95
~ r~ :--~
~ O ~ r ~ ~ O x O t~ p C7 ~ ~ ~y y
~ d ~. - ~ ~ ~ ~ ~ ~ C" y ~ b y n ~ ~ b7 ~..~
-t, ~ S .~ . ~, o En
~ C ~ C~ ~ Z ~
~ ~ A ~
~ Z ~ ~ - ~ ~ m m ~ ~ ^^
~ m G9 .~ d Cl ~ ~ 1
7 ~ ~ ~ ^ ^ ^ n ^ ^ C ~ F~
o ~ a r~ ~ ~ to m ~ '• J ° -~i
°Q o
cn o '< A
~ ~ D z o ~ %~
~ 0 ~' ~ ~ ; ..~ o
~d
~ o ~ O
y
,.
1 a ~s _ ~ ~ ~E~w o0 0.
y~,I,LSS~~
~~
~ aJ.U-~a~
c~ c
~~~ ~~~
~-~ ~-~
~~~