BP4960BUILDING PERMITAPPLICATIOIV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
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Application Date: ~ I ~ I~ ssue Date: ~~~
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~~ 496Q
Permit - -
Permit Fee: ~
JOBADDRE
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LEGAL
1 ' DESCR. LOT NO. LK.
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1
- ~ SEE ATTACHED SHEET
,Z. OWNER MAI ADDRESS ZIP PHONE
,3. CONTRACTOR MAILADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ~j,ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: '
7, Sq. FOOtage of StrUCture (Including Basemen) and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodway Yes^ No ^ Dev.Permit
Fringe Yes^ No ^
BFE EIev.Cert.
11. Current Zoning: Site Plan Attached ^ Complete Plans Attachec
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date y 1'> t ~ I
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ Utilities
14. Variance Required: Yes ^ No ^ Sewer Tap Water Tap
Sewer Water Service
15. Minimum Setbacks: Front Side Rear Septic emote
16. Sidewalk Required: Yes ^ No ^ Waiver Approved '
ding
AP CATION ACCEPTED BY PLANS CHECKED 8Y APPROVED FOR ISSUANCE BY Footings Drywall
NOTICE
Framing (before finish) '
Final ~' ~-~-~2-- ~
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tinning, and septic systems. By my signature below
I achnowledge that payment of the /
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buildin
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it
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d Electrical
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app
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oes 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 Rough-I Fixtures
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth Final Permanent Service
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. Mechanical
Rough-in ABC
SIGNATURE OF OWNERfCONTRACTOR OR AUTHORIZED AGENT DATE Final
- Plumbing
Ground Work
SIG AT RE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv d
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?OUNDS PRTG: Blair, NE ~ pnv inw~
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CITY OP BLAIR
Application for Building Permit
PLOT PLAN
Address _ (/2~0~ ~ ~ ~ Date r ~~ °' 9~
Legal Description: Lot - ~~ Block ~^ ~ ~~ `',~ j
Additio ~~'
Please show all measurements of existing and contemplated struc~rures, .'~
also show distances between structures, ete., and property lines.
Is this a corner lot?
._ ~~~,
~ ProAeri°v
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_ _Center Line _ _ _
Applican
Str~_ _
Tndicate~orth