BP5276BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
Permit
5276
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L-I ~ ~~ ~~'~~ Issue Date: 1-~~~ -~~ Permit Fee: $
JOB ADDRESS l! ~_ -
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1, D SCR, _
LOT N0. ~~~ I
(p BLK. ~ ~ TRACT
^ SEE ATTACHED SHEET
OWNER MAILA DRESS ZIP
2. -'~ L ~ ~~,~ tl.'~k,1-,2C,~ ~ PHONE
^ '////11 + MAILADDRE~SIS rt ~ PHOAN~
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3. CONTRACTO)~' ~ ~ ~V lLt.~ 'l. ~1,~.~.~ ~~~• L~~~VO /V ~ ~/1 l , LICENS)_N0.
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USE OFBUI
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4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6, Describe Work: `j ~ ~, ~ I ( -~ ~ (5 {~
], Sq. Footage of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work; $ (~ ~L1 , ~~~
10. FIOOdplaln: Floodway Yes^ No ^ Dev.Permit EIev.Cert.
Fringe Yes^ No ^ BFE
11. Current Zoning:
12, State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes^ No^
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~'>>0 ~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
CATION
15. Minimum Setbacks: Front Side Rear septic
16. Sidewalk Required: Yes^ No ^ Waiver Approved
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 copyof this application form signed bythe Building Inspector and stamped
'APPROVED'.
I hereby agree ~ erform the proposed work in accordance with the specifications setforth
above and in~ac rdance with t e w rdinances of the City of Blair and the State of
Nebraska. I nd stand that t s F i s id if work is not commenced within 180 days
or is not co within 2 e s t i ue.
0
GN / iC0 RACTOR OR AUT ORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Remote
~~ k"~/3= <~f~~l ~ 1~~~' ~n~
Building
Footings Drywall
(before finish)
Framing Final ~ Z ~ ~ ~ -°~
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
Comment: Approve y: ~
Rev. 1019'
Mechanical
- ABC _
YVUNUJ YH I li: tl191f, NC