BP5073BUILDING PERMITAPPLI
- Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CA`f ION
Permit N® 5073
Application Date: ~-~~~ `1 ~ Issue Date: / ~' ~- 9~ Permit Fee: $ ~~ ~~
JOB ADDRESS ' ~~~ ~ r, _ f C~_~
1, LEGAL
DESCR. LOT NO. ~ BLK. ~ TRACT ~ ~ ^ SEE ATTACHED SHEET
/~ (/~/~ [~ M~~~ f / /~ f / ~ p
2. OWNER ~Qr L)1 n l l /C 11 I ~} ~ RESS I `I- ~C ZIP ~7 U9 ''7 y0
3. CONTRACTOR MAILADDRESS PHONE LICENSE NO.
~C~
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~_,~ d_ ~, ~~~
7, Sq. FOOtage of StrUCtUre (Including Basement and Garage): 1 V ` X ~/ +
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~O ,
Floodway Yes ^ No ~ Dev. Permit
10. Floodplain: Fringe 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 _
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 nd that this permit is void if work is not commenced within 180 days
or is n ompleted within 2 year ate o 'sue.
G ATURE OF OWNERJCONTRACTOR OR AUTHORIZED A T DATE
Site Plan Attached ~ Complete P ans Attached ^
Approximate Completion Date ~~ '~" ~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
Framin (before finish)
Final ~''~~.- ('~-t-'~
g
+ (~ ~'~~
Electrical
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: Approv d By: -.
'OUNDS PRTG: Bleb, NE Rev. 109
(~~ ~~~ Is av~.~
CITY OF BLAIR c_rZ~_ ~~ r~~
Application for Building Permit U~ ~ /4 UU
PLOT PLAN
Address /~2 7 ~O~T JT Date y' - ~ ~ ~'~
Legal Description: Lot Block --`~° Addition G'Ty olG ~~
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot? ~_
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Indicate North
~, _Center Line_of _ _ _ ~',ei~j' Street_ _
-- Applicant -