BP5220BUILDING PERMITAPPLICATIOrI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 N~ ~ 5 2 2 0
(402) 426-4191 Permit
Application Date: -2 - ~ ~~ ~~~ Issue Date: C~` I ~' -C+~ Permit Fee: $ 6 ~ ~~
JOB ADDRESS
j (off ~~~c2<S ~1 ~rl
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER MAIL ADDRESS ZIP PHONE
~ C~C_l'Li -~-
CONTRACTOR MAILADDRESS PHONE ~ LICENSE NO.
4, USE OF BUILDING
5. Class of Work: NEW ^ ADDITION []ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6, pescribe Work: _~_~C ~~ .._- C-~1~`(u~'~_
7. Sq. Footage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ) (x,~ . ~~
10. Flgodplain: Floodway Yes^ No ^ Dev. Permil 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 _
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 copyof this application form signed by the Building Inspector and stamped
'APPROVED'.
I hereby agreet perform the proposed work in accordance with the specifications setforth
above and i rdance with the codes~ord' ty of Blair and the State of
Nebraska, nderstand that~s permit'.. oid ify~ork is not co menced within 180 days
or Is not mpleted within ~d of ' . e.
_ ~~~~~~
SIGNATURE OF OWNERtCONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ~ Complete Plans Attached ^
Approximate Compl Ion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
4 Building
Footings 9
beto fi~
Framing 'nal
Electr r<a
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appro d y ~
__. .___ ____ _.. .._ Rev. 1019
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2A' E~1 RAR~:AIf RA~(,4TNC~ URACE A AODKK:{BACKS(1' % 1' S0
AU,LM I~6NG)1' G~CKfk,OM FACE $OiNO SNACCdVS).
FRAN~'Vll$'w (k,X1S°~' iN xa~uu~
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SCALD; 3/4"=:1'• a"
CQN~Q4IDATCA S~G~t
SPECS:EXIST SIf AWNING (DOOR ENTRY)
REFURB WI NEW FLEX SIGN MAT (COOLEY 5019 TEAL) ERA~D
WHITE COPY & LOGO• MAKE APP
CHANGES TOFRAME-RELAMPAS flE~.
EGG CRATING OPTIONAL.
NOTE DETAIL ON SI~EVIEW TO ALLOW MAX FACE AREA.
*NOTE: IF POSS THICKEN LINES ON MAN tHi ri<vv~ ~~,~; ~ro~v~
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