BP5051BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Perm=° 5051
Application Date: ~' ~I wl ~ Issue Date: 1 ' ~ ~ "9 Z Permit Fee: $ ~ • ~
JOB ADDRESS ~~ ~ ~ ~ C.~ ~l ~ ~ ~~\
LEGAL
1 • DESCR. LOT NO. ~
I BLK. TRACT
I I ~~ $ ~ I J
^ SEE ATTACHED SHEET
2. OWNER ~ ~ (z ~~~ r U' ~ n ADDRESS C~~- Zlp
v
~ L ~ P,~iO~E~
I
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~
AILADDRESS PHONE
M
3. CONTRACTOR LICE
N
S
ENO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ Yl C ~ _ ~ ~ ~~I~ ~ ~ ~,~ ~' f ~yYL ~ ~ LUG
], Sq. FOOtage Of Structure (Including Basement and Garage): ~ I ~ .~ `/~ ~ I 'rcn
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ 2 ~U. (~~
10. Floodplain; Floodway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit Elev. Cen.
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 _
ACCEPTED 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 to perform the proposed work in accordance with the specifications set forth
above and in accord a s rdinances oft a City of Blair and the State of
N terse t that thl a it is void if rf~ho ommenced within 180 da s
r s ~ mpleted aw~' hi year , e.~ / ~ ~
OF OV~NERICONTRACTOR OR
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~~'/-q7_
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish _r nn
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t '(0~2 - O['~/1'1~
Framing _
.,
Final
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Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
iFiough-in ABC
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 B ; -, ~
~~