BP5148BUILDING PERMITAPPLICATIO~IV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 N~, 514 8
(402) 426-4191 Permit
Application Date:
I I -~~l~qZ
Issue Date: 1 ~ ' z~ `~ ~- Permit Fee: $ ~0 • ~ 0
JOB ADDRESS ~ ~ ~ ~ I S r ~~ •
LEGAL
1. DESCR. LOT NO.
i/ SWIy S BLK.
r/
7"~ d "~~ TRACT
^ SEE ATTACHED SHEET
2, OWNER ~ ~ MAILAD RESS ~ ~ ZtP, ^ ~ PHONE
-
ll `--
CONTRACTOR MAIL ADDRESS LICENSE NO.
PHON
E
USE OF BUILDING
4.
5. Class of Work: [~ NEW ^ ADDITION []ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~n ~_ ~ ~ r C~7 a~ ~~ ~~
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~DOC~ • dC~
10. Floodplain: FI°Ddway 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
APP ACC- l~Ir~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 tee 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 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 wlthila 2 years of date of issue,
TORE OF
AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date /~~3U "C( Z
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
2~ Z„ q 2
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved '' 11``
POUNDS PRTG: Bleb, NE nav. iulal