BP4806BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~" 3U " 92- Issue Date
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~~ - - asos
Permit Fee: $ (~~ ~d
JOB ADDRESS ) / ~ ~ CC
/ CO
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~
~J CAS ~~10 ~~ ~ AILADDR SS ZIP
~ GLc S-~ PHONE
3 CONTRACTOR ,~
c,~- ~-rU ~ ILADDRESS PHONE
~ C~ ~/ . LICENSE NO.
~ ~-570
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: '~~,~~ ~~ ~~~,
]. Sq. FOOtage Of StrUCture (Including Basement and Garage): i
8. Change of Use From: Change of Use To: '`
g, Valuation of Work: $
10. FIOOdplaln: Floodway Yes^ No ^
Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert.
11. Current Zoning: Site Plan Attached ^ Com lete Pl~ns Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date ~ 3 ' ~~
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No ^ sewer Water Se ~i
15. Minimum Setbacks: Front Side Rear septic mote
16. Sidewalk Required: Yes ^ No ^ Waiver Approved B ldin t
ICATION ACCEryPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
~ rah I nA _ (before f rn i i
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 acopy 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 is not pleted within 2 years of date f issue.
SIGNATU OF OWNER~CONTRACTOR 0 THORIZED AGENT DATE
Framing
Rougl
Final
Temp
Rough-in
Final -
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
CATI O N
Permit
Fixtures
Permanent Service
,.,,..,,~anical
ABC _
POUNDS PRTG: Bleb, NE Rev. 10/91