BP4972BUILDING PERMITAPPLICATIO~I
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 ~~ 4972
(402) 426-4191 Permit
~' ,.
Application Date: ~:~ Issue Date: ~/~~~~-~~ Permit Fee: $ ~ O~
JOBADDRES J ~
T' /
C
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. - L ESS ~ R
J \ ONE
3. CONTRALTO MAIL ADDRESS NE ICENSENO. /
USE OF BUILDING
4.
5. Class of Work: ^ NEW ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~8 ~r , ~ ,~ ,~ /~G A 2
]. Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~
10. FIOOdplaln: Floodway Yes ^
Fringe Yes^ No ^ Dev. Permit
No ^ 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 _
AP ;~ f6t~~ TAD BY I PLANS CHECKED BY I APPROV~ R ICE BY
NOTICE
S parate 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 acopy of this application form signed bythe Building Inspector and stamped
~~ 'APPROVED'.
I hereby agree t e~orm the proposed work in accordance with the specifications setforth
above and ' aca~yante with the codes~ordinances of the City of Blair and the State of
Nebras . I t;nd~fstand that this pe~i s v id if work is not commenced within 180 days
or is co ,p eted within 2 ye 9f~date issue, r
SI~PGATURE OF OWNER)CONTRACTOR OB.AITrrIi~RIZED~4GENT ~ ' NATE
Site Plan Attached ^ ~Eo plete Plans Att ch
Approximate Completion Date I
Inspections Required d Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Buil 'ng
Footings ~ rywall
(before finish)
~j~ n
Framing Final ~P~~~ ~ -r~`i
Electrical
Rough-i Fixtures
Final Permanent Service
Tempor ry Service
Mechanical
Rough-in ABC
Final
Ground Work
Plumbing
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve By: /~~
/W/J/
'OUNDS PRTG: Blelr, NE ~ Rev. 10~&