BP5394BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~ --2_ ~ ~~ ~ Issue Date:
~~- G~~ ~~
Permit ~ ~4
Permit Fee: $ ~- ~
JOB ADDRESS
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LEGAL
1• LOT NO. ~ BLK. ~ I
L TRACT ~>~
^ SEEATTACHEDSHEET
DESCR.
iMAILADDRESS ZIP PHONE
OWNER ~
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2
V
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GTC
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.
MAILADDRESS~/ PHONE LICENSE NO.
3. CONTRACTOR / ~
USE OF BUILDING
4.
5. Class of Work: ~ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~~,~~~ ~ ~~ ~l
7. Sq. FOOtage of StrUCtUre (Including Basement and Gerage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FI°Ddwey Yes^ No ^ Dev.Permit EIev.Cert.
Frin
e Y
^ N
^
g
es
o
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 _
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 constructicn 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 not ce pie d withi ears of to of is ue. ~
OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
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)
Framing Final
Electrical
Rough-in Fixtures
Final ~ ~ e e rmanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Ground Work
Rough-in _
Plumbing
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTD: Blair, NE ~ - Rev. 10~9f