BP4988BUILDING PERMITAPPLICATIO~iV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 p 49 $ $
(402) 426-4191 Permit - - ~ - -
Application Date: 7- ~~ ~~. Issue Date: ~ _ ~ ~~- ~ ~ Permit Fee: $ i0. ~
JOB ADDRESS
D,
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LEGAL
1 LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
OWN R
2. MAILADDRESS Zlp PHONE
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3, CONTRACTOR MAIL AD ~ ESS
` LICENSE N0.
PHONE
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LLB ~
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7
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USE OF BUILDING
4.
5. Class of Work: '~.NEy~/ ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: i
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~ ~ ~ _ ~y ~
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], Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
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FIOOdplaln; Floodway Yes^
10 No ^ Dev. Permit Elev
Cert
.
Fringe Yes^
No ^ 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 PLANS CHECKED BY APPROVED FOR ISSUANCE BY
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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 copyof this application form signed bythe 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,?~bt complelgd within 2 years of dad o~ issue.
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZL'gAGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap ~,
Sewer Water ewi ' ~~ D ~ Q ~ 3
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final ~ ~~'
Electrical ~~Cl ~~
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Comment: Appro~e~~:~-~~