BP5485BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION ~~
Permit 5 4 8 5
Application Date: ~-/~ -T,3 Issue Date: ~ ° ~~ '"~~ ~ Permit Fee: $ • C~`-
JOB ADDRESS
1. LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2. OWNE MAILADDRESS ZIP PHONE
--~~ ~Ld-sue
3 CONT CTO MAILADDRESS PHONE LICENSE NO.
USE OF BUILDI
4.
5. Class of Work: [~ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: J ~~~~
7. Sq. FOOtage Of StrUCtUfe (Including Basement and Garage):
$. Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Flooawey Yes^ No ^ Dev.Permit EIev.Cen.
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^
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
APPLICATION ACCEPTED BY f 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 copy of this application form signed by the 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 completed within 2 years of date of issue.
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in ~ixtures
Final ~~ Permanent Service
Temporary Service _ ~ ~ ~L ~" ~7~~
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appro e?i B
noUNOS PRTG .Rlalr. NE RBV.10/9'
~.
CITY INSP~~TIQN SLIPS ~l
Inspection has been requested for / "/ti')~ ~/~U'"~~
Location of Building
BY
Name of Comp ny
pn ~~ ~ ~ o
Typ. of Inspection
At
Date Time
Results of the Inspection are: A,: (~7
I
City ~tepresentative
~~
t
' _ s ~ .