BP5323BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
5323
f ~/ n ~ o0
Application Date: ~ /:~C~~ JG(~ Issue Date:, .~ ~1~ " 1 ~ Permit Fee: $ ~~jt~ -
JOB ADDRESS
4 C N .
I ~~`~'-'
LEGAL
1 . DESCR. LOT NO. ~
~ BLK. TRACT /~
~~ ~ )` ~ I ~ (~ , ~ C ~ SEE ATTACHED SHEET
~S
2. OWNER,~~
YL ~~~~4 MAILADDRESS YI PHONE
~_c~ Z ~~
3• CONTRACTOR i
' ~ MAILADDRESS PHONE UCENSENO.
Q
USE OF BUILDING
4.
5. Class of Work: ^ NEW ~DDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: `~~~ g x ~~ ~ ~ .
]• Sq. FOOtage of StrUCtUre (Including Basement and Garage):
$. Change of Use From: Change of Use To:
~e
g, Valuation of Work: $ '~~ ~~ L~ --
10. Floodplain: Floodway Yes^
Fringe Yes ^ No ^ Dev.Permil
No ^ BFE Elev. Cert.
11. Current Zoning: ~1 ~
12. State Fire Marshall Required: Yes ^ No[~
13. Special Use Permit Required: Yes ^ No [~
14. Variance Required: Yes 0 No [~"
15. Minimum Setbacks: Front~Side ,~_ Rear ~-~
16. Sidewalk Required: Yes^ No ['VIlaiver Approved
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date 1 ~ 1 ~31
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic .Remote -
Building
Footings ~ ~~'- 7 ~ Drywall
(before finish)
' • ~ 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 bythe 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~ of ompleted within 2 years of date of issue.
( ~- fi .-~~3~P.~
9
SIGNATURE OF OWNERfCONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Framing t~ Final ~ ~, 3
Electrical
Rough-in t/ Fixtures
Final ~~ Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv By ~
POUNDS PRTG: BI°Ir, NE R°~• ~~~
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CITY INSPECTION SLIPS
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Inspection has been requested for ~ ~ ~ ° 1'S
Location of Building
Narne of Company
On ~CS`u `~"'~
Type of Inspection
At ~ ~~ ~ ~? ~ ~ ~~
;date Time ,.~} •
Results of the Inspection are: ~ / ~~
~~~~FA
City Representative
•_ CITY INSPECTION SLIPS
Inspection has been requested
By ,
Name of Company
s
On ~-
Ty e of Inspection
At ~ ~,~
Date Time
Results of the Inspection are:
N
r
City Representative
for ~~d ~~~ ~~
Location of Building