BP4751BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit ~°' 4751
Application Date: ~ ~ "~2 "~1~ Issue Date: ~j "~2 "~~ Permit Fee: $ CO~ ~~
JOB ADDRESS
I ~l 52 ~ ~ i b ~ ~r
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~ ~ ~~ l ~~ ~O ~5~~ DDRESS 1 ~ ~ ~ 1 . \ t. ~ ~ ~ r Z,P
1 lJl1
T PHONE
MAILADDRESS
PHONE
3. CONTRACTOR
I-~-oYne ~Ocun c~~~n a3 ~ ~ C ~ r. LICENSE NO.
.~/ai~~
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ~ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~rnO~G~ ~e ~~~~ m ~~-~
7. 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: FriDga 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 _
APP~~ I~ ACY ~( rJ. 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 setforth
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
ohs-ae5completed wlthiD 2 YearsAf date of isstt~.
SIGNATURE OF
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date I l r l 2- ~
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
Mechanical
Rough-in ABC
Final o-CCU D ~ j~~~~s
Plumbin
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve ~
ti~.~.. ~rrZ ~
'OUNDS PRTG: Blalr. NE Rev. 1019