BP5251BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~- 2~~I-~~ Issue Date:
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_ ~_ ~,~
CATION
Permit
5251
Permit Fee: $ ~S ~ ~~~
JOB ADDRESS
12~.~ ~ S ~-c~-~--~
LEGAL
1 ' DESCR. LOT N0. ~ ~ I/2 BL~ ~.~ TRACT ^ SEE ATTACHED SHEET
2 OWNER ,/~1 ,,,^ ~ ~ f~, ASS ZIP
Y
~ PHONE
AILADDRESS ~ ~ j ~ ~ j fry PHON~~~
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3. CONTRACTOR /~~I~~ ~ )~
t!' (~ ~j ~ LICENSE ~%~~
Zt/D
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~,
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~ (;I
10. Floodplain: FI°°dWay Yes ^ No ^ Dev. Permit Elev. Cert.
Fringe Yes^ Na ^ 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 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 understa hat this permit is voi 'f w rk is not commenced within 180 days
o is no lete withi 2 year ate is e
(GNAT RE OF OWNER~CONTRACTOR OR AUTH GENT DATE
E,
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and ees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
~
~
~ ~'J
Framing _u;
Final U~`
-
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 By: ~
..~ ~.~.... ....... .,~_,_ .~~ Rev. 1018