BP5292~• E~UILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 2 9 2
(402) 426-4191 Permit
~~-2- ~S -~~ Issue Date: y ~ 2~~ '~ Permit Fee: $ ~S ~
Application Date:
J08 ADDRESS ~ ~ ~ N I 2 L/ ~/~ ~ .
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LEGAL
1' DESCR. LOT N0.
~~ ~/ BLK. TRACT Q , `
.~D7/ /~~~~~ I ~- ^ SEE ATTACHED SHEET
2. OWNER / , ~ ~1~~ADDRESS ~ ZIP ~Or Cl ~ „\ ~E
3. CONTRACTOR MAILADDRESS PHONE
Scc_.~_ LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION EPAIR
^ ALTERATION ^ R ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~,~ hOlr(~e-- /
(/}~ ~/~2~ l G~.-~/ ~ ~2 X ~~/ /
7, Sq. Footage of Structure (Including Basement and Garage>:
$. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~
10. FIOOdplaln: Floodway Yes^ No ^
Fringe Yes^ No ^ Dev.Permit EIev.Cert.
BFE
11. Current Zoning: Site Plan Attached [~ Complete Plan Attached ^
~
-~ ~~
e uired: Yes ^ No^
12. State Flre Marshall R q o
Approximate Com letion Date
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No ^ sewer Water service
15. Minimum Setbacks: Front Side Rear Septic Remote
16. Sidewalk Required: Yes ^ No ^ Waiver Approved Building
APP ICATIO ACCEPTED BY
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~ ~ PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(beforefin(sh) ! C 2 - ~Gr 11~.~G.~(
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NOTICE Framing ~
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Final ~ /
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge that payment of the Electrical
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 Rough-in Fixtures
have received acepy of this application form signed bythe Building Inspector and stamped
~APPROVED~. Final Permanent Service
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
Temporary Service
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not completed within 2 years of date of issue. McChaniCal
Rough-in ABC
SIGNATURE OWNERJCONTRACTO R HORIZED AGENT DATE Final
Plumbing
~ y~ Ground Work
IGNATURE OF OW R OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approu d By: l
0
Rev. 1018
rwnus rn i u: nieir, nc
CITY INSPECTION SLIPS
L~
Inspection has been requested for p~~ /L~
^Location of .Building
By
Nam of Company
On
yp 2of Inspection
Dat Time
Results of the Inspection are: /~ ~~_
C~ Representative
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