BP5214BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
- 218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
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Application Date: ~- `7 ~~- ~ Issue Date: ,~-- ~ ~~~ Permit Fee: $
JOB ADDRESS
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-
~
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER Cc, /~~ ~~ MAILADDRESS ZIP
~ PHONE
r3 CONTRACTOR
~~ ~ ~ ~ .- - ~~ IL ADDRESS ~~ ~ ~ ~~~~~
- ~ ~~~~ LI NS N0.
~ ~%/-~ ~~~~Z
4. USE OF BUILDING
5. Class of Work: ^ NEW ^ 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: $ ~ ~~,
Permit
10. Floodplain: F~ rya ey
B
Yes[] No ~
FE Elev. Cert.
~ 1. current Zoning:
12. State Fire Marshall Required: Yes ^ Nod]
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes^ No^
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Requirt~d: Yes^ No ^ Waiver Approved _
TION 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, ~y 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 ofthls application form signed bythe Building Inspectorand 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 d ~t this per it''s v id if e k is not commenced within 180 days
or Is notes pleted i ~ years o d t of iss e
ti~
IGNATU E OF OWNER~CONTRACTOR OR AUTHORI GENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~ -- y ~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
Building
Footings Drywall
(before finish) ~,~~ sF
Framing Final ~~~~~°~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Rough-in
Final _
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
CAT10~1V
Mechanical
- ABC
Comment: Approv
...,.-
'OUNDS PRTO: Blelr, NE