BP4978BUILDING PERMIT APPLICATIO~iV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street ~~ ' - 4 g ~ g
Blair, Nebraska 68008 " - ~ -
(402) 426-4191 Permit
Application Date: tp1 ~ylc1~ Issue Date: /~~/~~ DO
Permit Fee: $
JOB ADDRESS
(~ ~
G1 ~v~-Y ~
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2, OWNER ~ MA A~R)=,S ZIP PHONE
3, CONTRALTO ~ ~ ~ MAIL ADDRESS PHONE LICENSE NO.
USE OF BUILDIN
4. Om--~.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~.t,J A- ~ ~~ LvtMOK.~~
], Sq. FOOtage of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FI°oaWay Yes ^
Fringe Yes^ No ^
No ^ Dev. Permit Elev. Cert.
BFE
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 _
APPLICATION 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 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 . t completed within 2 year of date of issue.
v4~ '~ 2-
SIGNATURE OF OWNERfCONTRACTOR Ofi THORIZED NT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish ,
w
Framing Final
Electrical ~ ~ Z ~~
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: Approve By: