BP5081-BUILDING PERMITAPPLICATIC~N
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 No 5 ~ 8 ~
(402) 426-4191 Permit
Application Date
~~ "~~~~
Issue Date: ~U, 7'' f~- Permit Fee: $ (n• Q~
JOB ADDRESS ~ ~ ~ N Z / S~' ~ I t
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2 OWNER /~ / ,n ^ ~ /n MAILADD SS .~,, /
/\~~ 1~~~"~~" \ ~i"!C ~~ ~ en 1 Lam-/ Zlp PHONE
~ ~
CONTRACTOR ~ MAILADDRESS
3. ~.~-~e~-mrz~'~ - e ~/C ~Z~ E. PHONE LICENSE NO.
3Z n~ /3oX 7~ 7 ~e/Y)0~7~ 7Zl - ~/
4. USE OF BUILDING
5. Class of Work: [NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~'nt2C~ ~' /Gdi U40 BTU ~ ~~"? ~/C
7. Sq. FOOtage Of StfUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain; Floodway Yes ^ No ^ Dev. Permil
Fringe Yes^ No ^ BFE Elev. 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
APPLICATION ACCEPTED 8Y PLANS CHECKED BY 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 thecodes/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's not completed wit 'n 2 ears of date of issue.
~~°~~~~
SIGNATURE OF NER~CONTRAC R OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date /D ~ ~9 ~-
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 Permanent Service
Temporary Service
Mechanical
Rough-in ABC ~~ • Od
Final • GO
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~. n )
W
'OUNDS PRTG: Blelr. NE S Rev. 1018