BP4852BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit ~~' _4852
Application Date: ~'~ ~ ~_ `~ Z Issue Date: ~ • 2? `~ 2- Permit Fee: $ ~ g-~
JOB ADDRESS ~ °
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2 OWNER MAILADDRESS ZIP
~S _~~d ~~f1~ ~J~.~f=z~l _>c~~~~ PHONE
3, CONTRACTOR (/ /+ ~(/i ( ~/ ~ M/A~IL``ADDRESS r y~ ~ PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~ 0. h Y001~---
], Sq. FOOtage Of StrUCtUre (Including Basement 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.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 _
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
~" " ' NOTICE
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
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 not completed within 2 years of date of issue.
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~~~~ %~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Rough-in
OF OWNERfCONTRACTOR OR AUTHORIZED AGENT DATE Final
Mechanical
ABC
Plumbing
Ground Work o0
GNATURE OF OWNER (IF OWNE BUILDER) DATE Rough-in I ~~ Final ~~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appro
~w
POUNDS PRTG: 91e1r, NE Rev. 1091