BP5417~1~rrn ~-~ (~JGt~ ~v~~'~a-cam ~J y h~r~ ~~ G,~~en 5 ~~~.3
BUILDING PERMIT APPLICATION ,~ /
Jurisdiction of City of Blair, Nebraska / VC~ ~E'i~~
218 South 16th Street
Blair, Nebraska 68008 5 417
(402) 426-4191 Permit
Application Date: ~ r Z " C~ ~ Issue Date: ~ `~7- C~ Permit Fee: $ ~~ ` ~~
JOB ADDRESS
~~x ~~
1 ' DESCR, LOT NO:~ ~ C ~~\ ~
L J BLK. TRACT ~ ~ ,~ r , n, ~ ~ / / E C~ ~m~ATTACHED SHEET
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MAILADDRESS
2. OWNER Zlp
PHONE
CONTRACTO~~
3. ~~ ~ MAILADDRESS
~ c ~ U~ LP ~--~'rl rr ~G ~~~1
~'C-~-1Y1 PHONE LICENSE NO.
~Z~ J~~~~
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: i `~-I `~ - C C\~ ~ .11 ~~ .` ~~~
~. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$. Change of Use From: Change of Use To;
g, Valuation of Work: $ J ~/!~~(~, ~)~
Floodway Yes ^ No 0~ Dev. Permit
11). Floodplain: Fringe Yes^ No p- BFE
EIev.Cert.
11. Current Zoning: ~ ~ C~-
12. State Fire Marshall Required: Yes ^ No[~
13. Special Use Permit Required: Yes ^ No 0-~'
14. Variance Required: Yes ^ No[r]. A
Site Plan Attached ~ Complete Plans Attached ^
Approximate Comp etion Date ~l D ~ ~ ~ ~~ ~~
Inspections Required and Fees
Utilities
Sewer-Tap Water Tap
Sewer Water Service
15. Minimum Setbacks: Front ~ Side ~ Rear
16. Sidewalk Required: Yes ^ No [~] Waiver Approved _
APP,LIC~O~ 1! CEP~Y ~ PLANS CHECKED BY I APPRO~~~yfQR~CE BY I
c 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 by the Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above in a ance with the code rdinan f the City of Blair and the State of
Nebr ska. nd rst nd that this permit s void if w k I not commenced within 180 days
or' ' of com let d ithin 2 years~d to of issue.
`~~~_~<
OF OWNE~iICONTRACTOR OR AUTHORIZED AGENT DATE
Septic Remote
Building
Footings ~ Drywall~~
(before flnlsh)
Framing ~ Final '~
Electrical
Rough-in'~ Fixtures
Final / Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
I Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve By:
r ~
Mi tune owm _wia, ua Hev. 1019•
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