BP4869BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit_
Application Date: '-, - ~ - 1 ~.- Issue Date: `~- ~ `~ ~~ ~ Permit Fee: $ ~
JOB ADDRESS
~y-1(~ a~~~
~Y•
LEGAL
1 , DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2 OWNER ~~ h r I b ~ ~ MAILADD ~SS ~~ ~ ~ ZIP ~ ~ PHONE C
3, CONTRACTOR 1
I C r10 ~ 1 ~ r~ ~ s MAILADDRESS PHONE
~I C7 Z ~1~1 YV\ ~ v1 S LICENSE NO.
o`. ~ ! C Z
USE OF BUILDING
4. O +~~,
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ~®.REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ Y-~ ~ ~ R ~ ( ~ ~ o a ,r o n ~~
7, Sq. FOOtage Of StfUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~ ~ ~ ~ 00
10. Floodplain: Flooawey Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit
BFE Elev. 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 eY 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 wpy of this application form signed bythe Building Inspectorand 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.
OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date L~_ I S -q Z
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building ~- ~~ 1
Footings Drywall
(before finish
Framing Final G 2
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
~.~~~~~ /~ ~~ez g round Work Plumbing
SI~TURE 0 OWNER (IF OWNE BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
##3`~~3
4
~® 4869
POUNDS PRTG: Bleb, NE ~ Rev. 1091