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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-