BP4805BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit
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Application Date: ~ ~ ~ ~ ~9Z--- Issue Date: ~ °~ '-~~ ~ Permit Fee: $ ~ ~ ~)~
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LEGAL LOT NO.
1 BLK. TRACT ^ SEE ATTACHED SHEET
' DESCR.
2, OWNER ~~
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USE OF BUILDING
4.
5, Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~ '~ ~~ ~
], Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FI°odway 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 _
TION ACCEPTED 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 by the Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codeslordinances of the City of Blair and the Siate of
Nebraska. I understand that this permit is void if work is not commenced within 1 BO days
or is not completed within 2 years of
~J~ to of issue.
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SIGNAT E OF OWNER~CONTRACTOR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Pla~n}s Attached LJ
Approximate Completion Date z~ ~" r ~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical ~ ~ 2~~~j2
Rough-In Fixtures /
Final ~~. C~ C~ Permanent Service
Temporary Service
Rough-in
Final -
Ground Work
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Plumbing
Final
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I oug -In
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
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Mechanical
ABC
Rev. to/sr
POUNDS PRTG: Bletr, NE
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CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OR
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THANK YOU KEEP THIS COPY FO OUR RECORDS.
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RECEIVED BY
EM^NUEL PAINTING. FNEMONT. NE 80020
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