BP5293BUILDING PERMIT APPLI
- Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~ ~ 2 ~ ~ ~~ Issue Date:
CATION
Permit
5293
Permit Fee: $ ~~' ~-'~~
JOB ADDRESS ~~ ~ ~ ; i /_
~-
LEGAL
1 ' DESCR. LOT NO.
~ ..Z ~~ ~ BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~C~~C~ ~~~I f1Ci~- Q rAILADDuRE~~ ~
C. .Lj~~ZJp PHONE
!~
/
MAILADDRESS
3. CONTRACTOR
~C ONE LICENSE NO.
PH
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: R~i J.~ ~n ~ ~~~~ ~--~
7. Sq. Footage of Structure (Irtdudi~g Basamantandcaraga>:
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ L~ ~/ C~C% d
Floodway Yes ^ No ^ Dev. Permit
10. Floodplain: Fringe Yes^ No ^ BFE
EIev.Cert.
11. Current Zoning: ~~-~ ,_,,/
12. State Fire Marshall Required: Yes L7 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 f PLANS CHECKED BY f APPROVED FOR ISSUANCE BY
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 bythe Building Inspectorand stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications setforth
above and in accordance with the codes~ordi ances of the City of Blair and the State of
Nebraska. I up er tand that this permit is~i"tl if work is not commenced within 1 SO days
or is not comb ed within 2 veers of dat f issye. _ ~JJ-)
TURE OF OWNERICONTRAC70tt"OR AUTHORIZED
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) Pf' Z 93
Fi
l '"L~ ~~
Framing na
Electrical
Rough-in ~ Fixtures
Final /~~ ~OC~ - ~ permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in '~ ~ Final / 12 0 iJ
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appro ~
BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit
Application Date: I ~ ~~ 1 ~ Issue Date: ~-~~ ~ 1~~ Permit Fee: $
5418
~aCY~
JOB ADDRESS ~C, ~ ~~ ! ~~~
LEGAL
1 ' DESCR. LOT NO ~ ~ '
l << BLK. TRACT
^ SEE ATTACHED SHEET
OWNER MAILADDRESS ZIP PHONE
2.
~ ~ ~~
~ n~KL ~' LGl1c
~
w ~~
~
~
,
~~
.
3. CONTRACTOR MAILADDRESS ONE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~%~C~ f ~ ~ ~~ ~ ~~~
7. Sq. Footage of Structure (locludlos Basement and caress):
8. Change of Use From: Change of Use To:
9, Valuation of Work: $
Floodway Yes ^ No ^ Dev. Permit
EIev.Cert.
10. Floodplain: Frinsa 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
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 acknowledge 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 wmmenced until I
have received a copy of this application form signed bythe Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications setforth
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 ~ not completed within 2 years of date of issue.
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 Fixtures
Final ~~ ~~~~, Permanent Service
Temporary Service
Mechanical
Rough-in q~C
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
Final
Ground Work Plumbing
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv d-