BP48944�
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 N® 4894
(402) 426-4191 Permit -
Application �y
pp Date: �"--� ��`'1 � Issue Date: � � �� Permit Fee: $ 15
JOB ADDRESS
1 , LEGAL
DESCR.
LOT N0.
BLK.
TRACj�A��`��/y'�C/
/vL
EI SEE ATTACHED SHEET
2.OWNER I I�
AIL ADDRESS�//, �G/Z� ZIP
Y (n
3. CONTRACTOR_ r MAILADDRESS PHONE
�_
LICENSE NO.
4. USE OF BUILDING
5. Class of Work: 4AEW ❑ ADDITION
❑ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
6. Describe Work:
7. Sq. Footage of Structure (Including Basement and Garage):
8. Change of Use From:
Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodway Yes ❑ No ❑
Fringe Yes ❑ No ❑
Dev. Permit Elev. Cert.
BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ❑ Non
13. Special Use Permit Required: Yes ❑ No ❑
14. Variance Required: Yes E] No❑
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ❑ No ❑ Waiver Approved-
ACCEPTED
pproved_
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 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 codeslordinances of the City of Blair and the State of
Ne raska. I understand that this permit is void if work is not commenced within 180 days
or s ompleted withi ears of date of issue.
%�'.�
SIGNATURE OF OWNERICONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ComgI to Plans Attached ❑
Approximate ComplVionDate (Q ln��1l5
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
( I-10 42 nlc, sFarled
Building
Footings 67
rywall
r ' (before finish)
Framing v Final
/ Electrical /I auu
Rough -in ( Fixtures
Final Permanent Service
Temporary Service
Rough -in
Final —
Mechanical
A\C -
Ground Work Plumbing
Rough -in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved�%��
'OUNDS PRTG: Bleb. NE Rev. 1019'
woq�,T> yw fp,.e'
(- ., . - --e' / if ) C
TO 1;G�17- CN.e
_----
/00 �'r
1 Go